Telehealth Provision Research Articles

Cross-State Licensure Laws for Telehealth Evolve During Pandemic

Cross-State Licensure Laws for Telehealth Evolve During Pandemic

Harm reduction and health services provided by syringe services programs in 2019 and subsequent impact of COVID-19 on services in 2020

ObjectivesThis study describes harm reduction and health services provided by U.S syringe services programs (SSPs) in 2019 and changes in provision of those services in 2020. MethodsSSPs were invited to participate in the Dave Purchase Memorial survey in August 2020. We collected programmatic data on services provided in 2019 and at the time of the survey in 2020. We conducted descriptive analyses using Chi-square and McNemar’s tests. ResultsAt the time of the survey, > 60% of SSPs reported increased monthly syringe and naloxone distribution and expansion of home-based and mail-based naloxone delivery in Fall 2020 compared to 2019. Approximately three-quarters of SSPs decreased or stopped providing on-site HIV and HCV testing. Nearly half of SSPs offering on-site medications for opioid use disorder (MOUD) in 2019 increased provision of MOUD in 2020. The proportion of SSPs offering on-site mental health care services and primary care services statistically significantly decreased from 2019 to Fall 2020, but telehealth offerings of these services increased. ConclusionsMany SSPs that offered health services in 2019 and remained operational in 2020 increased telehealth provision of mental health and primary care services, increased MOUD provision, and expanded harm reduction services, but most SSPs reduced or stopped on-site HIV and HCV testing. Sustaining SSP growth and innovation is paramount for preventing overdose deaths and HIV/HCV outbreaks after the deadliest year of the opioid epidemic in 2020.

Online conferencing platforms as operational tools by health professionals: A pilot study

Due to the COVID-19 pandemic, health professionals provided their services online or by telephone. The science of telemedicine is helping to reduce social inequalities, improve health services, and support patients with chronic diseases regardless of geographic location, income, or educational level. This study aimed to investigate the degree of familiarity, skills, and satisfaction of health professionals with the provision of telehealth—the use of remote therapies in times of emergency, such as a pandemic. The analysis of the results showed that although health professionals feel familiar with the electronic platforms for teleconferencing, they need training and technical support to automate their electronic services to become as functional as the face-to-face sessions. The study contributed by identifying limited knowledge regarding the credentials and potentials of online teleconferencing systems on behalf of health experts.

The impact of telehealth policy changes on general practitioner consultation activity in Australia: a time-series analysis.

Objective To examine the impact of telehealth policy changes on general practitioner (GP) consultation activity in Australia, during the coronavirus disease 2019 (COVID-19) pandemic, from January 2019 to December 2021. Methods An interrupted time-series analysis was conducted to analyse the impact of two major policy changes, introduced through the Medicare Benefits Schedule (MBS), on GP consultation (in-person, videoconference, telephone) activity. The first policy change was the introduction of additional COVID-19 telehealth funding through the MBS on 30 March 2020. The second policy change was the limitation on telephone consultation length to under 20 min on 1 July 2021. The rate of GP telehealth provision and activity was compared between pre-and post-intervention periods, separated by these MBS policy changes. Results After the first policy change, there was a significant increase in telehealth provision, with a simultaneous decrease in in-person consultations (P < 0.0001). However, telehealth provision decreased in the months following this first policy change (P < 0.0001), while in-person activity increased. After the second policy change, the initial videoconference provision increased (P < 0.0001). However, all telehealth activity decreased afterwards. In the months following the second policy change, the decrease in monthly activity for in-person (P = 0.700), telephone (0.199) and videoconference (P = 0.178) consultations was not significant. Conclusions The introduction of additional telehealth funding and limitations on telephone consultation length encouraged the initial provision and growth of telehealth services. However, these policy changes did not sustain the long-term upward trajectory of telehealth activity. Telehealth policies should increase opportunities for appropriate and sustainable GP telehealth services.

Independent mental health providers’ experience in initial months of the COVID-19 pandemic.

This study focused on experiences of mental health providers in independent practice in the initial months of the COVID-19 pandemic. We aimed to understand transition to telehealth, stress, and if self-care and emotion regulation were related to stress level. Participants (N = 207) were mental health providers in independent practice. Participants completed the Perceived Stress Scale (Cohen et al., 1983);Emotion Regulation Questionnaire (Gross & John, 2003);and Self-Care Assessment for Psychologists (Dorociak, Rupert, Bryant, et al., 2017) in alternating order, and answered questions about personal and professional demographics, type of independent practice, and stressors and supports during COVID-19 (closed-ended and open-ended questions). Results indicated that participants rarely used telehealth prior to COVID 19 (with 46.80% stating they never used it and 42.36% stating they used it less than a quarter of their time) and had a rapid shift to telehealth provision (with 72.91% exclusively using telehealth shortly before or after the declaration of the pandemic). Most participants reported only moderate stress during the early months of COVID-19. For emotion regulation, increased use of cognitive reappraisal was associated with less stress, but increased use of expressive suppression was associated with increased stress. All facets of self-care were associated with less stress-having professional support, engaging in professional development, having life balance, utilizing cognitive strategies, and aiming for daily balance. Participants indicated a wide variety of stressors, some related to practice and some to the pandemic, as well as sources of support, including colleagues and professional organizations. (PsycInfo Database Record (c) 2021 APA, all rights reserved) Impact Statement Mental health providers in independent practice made a rapid shift to telehealth in the initial months of the COVID-19 pandemic. Higher utilization of adaptive emotion regulation and regular self-care strategies were associated with lower provider stress, emphasizing the importance of regular use of these strategies. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

Symptom Experiences and Needs of Older Persons Living with Hemodialysis in Relation to Integrating Home Telehealth into Holistic End of Life Care: Phase I

Abstract The integration of home telehealth into holistic end of life care with nurse oversight for older persons living with hemodialysis is still limited in Thailand. This study explains the symptom experiences and health care needs related to integrating a home telehealth model into end of life care for older persons living with hemodialysis (OPLH). The paper represents the first phase of a mixed methods exploratory sequential study with dominant quantitative components, carried out over a six-month period. Purposive sampling was used to collect data from 100 OPLH. The instruments included the VOICES (View of Informal Carers Evaluation of Service-ESRD/Thai – patients’ version) questionnaire, the 9-item Thai Health Status Assessment questionnaire, and a demographic data form. The quantitative data were analysed using the statistical package SPSS version 17. Most of the participants had comorbid conditions (98%). The most common of these were hypertension (41.02%) followed by diabetes mellitus (23.25%). 25% had shortness of breath, and some had pain (31%), swelling (31%), anorexia some of the time (30%), and nausea and vomiting (15%). Moreover, participants also had symptoms of anxiety (23%), and moderate stress (10%). 8% had to be readmitted to hospital at least twice per month. Most participants had never received home care. The needs of the participants in relation to their holistic end of life care at home were reported in terms of: 1) knowledge of symptoms management at home; 2) activity and role management; 3) emotional management; and 4) spiritual support. The telehealth provision was mentioned by participants as an important part of their care, requiring VDO visiting, telephone counselling, and web-based education/ monitoring. Keywords: ESRD, Older persons living with hemodialysis (OPLH), Home telehealth.

Mental Health Service User and Worker Experiences of Psychosocial Support Via Telehealth Through the COVID-19 Pandemic: Qualitative Study.

BackgroundDuring the COVID-19 pandemic, we saw telehealth rapidly become the primary way to receive mental health care. International research has validated many of the benefits and challenges of telehealth known beforehand for specific population groups. However, if telehealth is to assume prominence in future mental health service delivery, greater understanding of its capacity to be used to provide psychosocial support to people with complex and enduring mental health conditions is needed.ObjectiveWe focused on an Australian community-managed provider of psychosocial intervention and support. We aimed to understand service user and worker experiences of psychosocial support via telehealth throughout the COVID-19 pandemic.MethodsThis study was jointly developed and conducted by people with lived experience of mental ill health or distress, mental health service providers, and university-based researchers. Semistructured interviews were conducted between August and November 2020 and explored participant experiences of receiving or providing psychosocial support via telehealth, including telephone, text, and videoconferencing. Qualitative data were analyzed thematically; quantitative data were collated and analyzed using descriptive statistics.ResultsService users (n=20) and workers (n=8) completed individual interviews via telephone or videoconferencing platform. Service users received psychosocial support services by telephone (12/20, 60%), by videoconferencing (6/20, 30%), and by both telephone and videoconferencing (2/20, 10%). Of note, 55% (11/20) of service user participants stated a future preference for in-person psychosocial support services, 30% (6/20) preferred to receive a mixture of in-person and telehealth, and 15% (3/20) elected telehealth only. Two meta-themes emerged as integral to worker and service user experience of telehealth during the pandemic: (1) creating safety and comfort and (2) a whole new way of working. The first meta-theme comprises subthemes relating to a sense of safety and comfort while using telehealth; including trusting in the relationship and having and exercising choice and control. The second meta-theme contains subthemes reflecting key challenges and opportunities associated with the shift from in-person psychosocial support to telehealth.ConclusionsOverall, our findings highlighted that most service users experienced telehealth positively, but this was dependent on them continuing to get the support they needed in a way that was safe and comfortable. While access difficulties of a subgroup of service users should not be ignored, most service users and workers were able to adapt to telehealth by focusing on maintaining the relationship and using choice and flexibility to maintain service delivery. Although most research participants expressed a preference for a return to in-person psychosocial support or hybrid in-person and telehealth models, there was a general recognition that intentional use of telehealth could contribute to flexible and responsive service delivery. Challenges to telehealth provision of psychosocial support identified in this study are yet to be fully understood.

The Determinants of Telehealth Provision: Empirical Evidence from OECD Countries.

Health services provided through the telecommunications system aim to improve the population’s health and well-being. This research aims to explore what digital, economic, and health factors are associated with the provision of telehealth services, especially in ageing communities. Applying Organization for Economic Cooperation and Development (OECD) countries’ experiences, this research tries to construct a logistic regression model between adopting a telehealth system or not, a binary outcome variable, and a group of potentially explanatory variables. Estimation results showed that there were thresholds for telehealth provision: The demand for telehealth service usually began when the provision of telecommunication accessibility reached 50%, the proportion of elders exceeded 10%, or the proportion of health spending occupied more than 3–5% of the gross domestic product (GDP); the slope of each variable seemed to correspond with an increase in demand for such a provision. A growing number of individuals in OECD countries are now readily served by telehealth systems under the COVID-19 pandemic. These findings could be regarded as a model for other countries for implementing the necessary infrastructure early on when any of these parameters reaches its threshold. Moreover, telehealth applied in developing countries could be elevated for wider populations to access basic health services and for the remote delivery of health care. A rational decision could be made to appropriately use additional resources in telehealth provision. With accessible e-health services, the population’s health could be improved, which in turn would possibly increase productivity and social welfare.

COVID-19, Telehealth, and Pediatric Integrated Primary Care: Disparities in Service Use

ObjectiveThe coronavirus disease 2019 pandemic (COVID-19) may increase pediatric mental health needs due to its social, economic, and public health threats, especially among Black, Indigenous, and People of Color and those served within disadvantaged communities. COVID-19 protocols have resulted in increased provision of telehealth in integrated primary care (IPC) but little is known about pediatric telehealth IPC utilization during the pandemic for diverse and traditionally underserved groups.MethodsA comparative study was conducted to explore variability between in-person (pre-COVID-19; n = 106) and telehealth (mid-COVID-19; n = 120) IPC consultation utilization among children 1–19 years old served through a large, inner-city primary care clinic. Logistic regression modeling was used to examine the association between service delivery modality (i.e., in-person vs. telehealth) and attendance, referral concerns, and several sociodemographic variables.ResultsService delivery modality and attendance, referral concerns, and race/ethnicity were significantly associated. The odds of non-attendance were greater for children scheduled for telehealth, the odds of children with internalizing problems being scheduled for telehealth were greater than those with externalizing problems, and the odds of Black children being scheduled for telehealth were less compared to White children.ConclusionThough telehealth has helped provide IPC continuity during COVID-19, findings from this study show troubling preliminary data regarding reduced attendance, increased internalizing concerns, and disparities in scheduling for Black patients. Specific actions to monitor and address these early but alarming indications of telehealth and Covid-19 related behavioral health disparities are discussed.

U.S. Policy Considerations for Telehealth Provision in Audiology.

The demand for telehealth services will continue to grow alongside an increased need for audiology services among both children and adults. Insurance coverage policies for audiologic services are specific to each payer and vary widely in the level of coverage provided for both in-person and telehealth-based audiology services. While benefits for children are fairly comprehensive, coverage for audiology services for adults is generally poor. Traditional Medicare does not cover hearing aids or other rehabilitative audiologic services, and other payer policies vary widely. Lack of benefits for hearing and balance services is inconsistent with the evidence base and leaves many beneficiaries without access to meaningful care for hearing and balance disorders, which are highly prevalent among and disproportionately affect Medicare beneficiaries. The purpose of this article is to discuss regulatory and reimbursement considerations for telehealth provision in audiology and elucidate opportunities to influence related health policy at both state and federal levels.

Greatly increased Victorian outpatient private psychiatric care during the COVID-19 pandemic: new MBS-telehealth-item and face-to-face psychiatrist office-based services from April-September 2020.

The Australian Federal government introduced new COVID-19-Psychiatrist-Medicare-Benefits-Schedule (MBS) telehealth-items to assist with providing private specialist care. We investigate private psychiatrists' uptake of telehealth, and face-to-face consultations for April-September 2020 for the state of Victoria, which experienced two consecutive waves of COVID-19. We compare these to the same 6 months in 2019. MBS-item-consultation data were extracted for video, telephone and face-to-face consultations with a psychiatrist for April-September 2020 and compared to face-to-face consultations in the same period of 2019 Victoria-wide, and for all of Australia. Total Victorian psychiatry consultations (telehealth and face-to-face) rose by 19% in April-September 2020 compared to 2019, with telehealth comprising 73% of this total. Victoria's increase in total psychiatry consultations was 5% higher than the all-Australian increase. Face-to-face consultations in April-September 2020 were only 46% of the comparative 2019 consultations. Consultations of less than 15 min duration (87% telephone and 13% video) tripled in April-September 2020, compared to the same period last year. Video consultations comprised 41% of total telehealth provision: these were used mainly for new patient assessments and longer consultations. During the pandemic, Victorian private psychiatrists used COVID-19-MBS-telehealth-items to substantially increase the number of total patient care consultations for 2020 compared to 2019.

Guam: The US territory where America's day begins but abortion access is still in the dark

Despite a constitutional right to legal abortion, residents of the unincorporated United States territory of Guam have no local access to abortion. Telehealth has the potential to address this need. However, current abortion restrictions in the Guamanian legal code in combination with the Risk Evaluation and Mitigation Strategy requirements obstruct telehealth provision of medication abortion.

Increased Australian outpatient private practice psychiatric care during the COVID-19 pandemic: usage of new MBS-telehealth item and face-to-face psychiatrist office-based services in Quarter 3, 2020.

Objective:The Australian federal government introduced new COVID-19 psychiatrist Medicare Benefits Schedule (MBS) telehealth items to assist with providing private specialist care. We investigate private psychiatrists’ uptake of video and telephone telehealth, as well as total (telehealth and face-to-face) consultations for Quarter 3 (July–September), 2020. We compare these to the same quarter in 2019.Method:MBS-item service data were extracted for COVID-19-psychiatrist video and telephone telehealth item numbers and compared with Quarter 3 (July–September), 2019, of face-to-face consultations for the whole of Australia.Results:The number of psychiatry consultations (telehealth and face-to-face) rose during the first wave of the pandemic in Quarter 3, 2020, by 14% compared to Quarter 3, 2019, with telehealth 43% of this total. Face-to-face consultations in Quarter 3, 2020 were only 64% of the comparative number of Quarter 3, 2019 consultations. Most telehealth involved short telephone consultations of ⩽15–30 min. Video consultations comprised 42% of total telehealth provision: these were for new patient assessments and longer consultations. These figures represent increased face-to-face consultation compared to Quarter 2, 2020, with substantial maintenance of telehealth consultations.Conclusions:Private psychiatrists continued using the new COVID-19 MBS telehealth items for Quarter 3, 2020 to increase the number of patient care contacts in the context of decreased face-to-face consultations compared to 2019, but increased face-to-face consultations compared to Quarter 2, 2020.

Achieving Equity in Telehealth: "Centering at the Margins" in Access, Provision, and Reimbursement.

The SARS-CoV-2 epidemic has led to rapid transformation of health care delivery and access with increased provision of telehealth services despite previously identified barriers and limitations to this care. While telehealth was initially envisioned to increase equitable access to care for under-resourced populations, the way in which telehealth provision is designed and implemented may result in worsening disparities if not thoughtfully done. This commentary seeks to demonstrate the opportunities for telehealth equity based on past research, recent developments, and a recent patient experience case example highlighting benefits of telehealth care in underserved patient populations. Recommendations to improve equity in telehealth provision include improved virtual visit technology with a focus on patient ease of use, strategies to increase access to video visit equipment, universal broadband wireless, and inclusion of telephone visits in CMS reimbursement criteria for telehealth.

The Future of Telehealth in School-Based Health Centers: Lessons from COVID-19.

In response to COVID-19, schools rapidly transitioned to virtual learning. School-based health centers (SBHCs) required immediate shifts from in-person to telehealth services to continue supporting students. A qualitative analysis of nationally-led "Listening and Learning" sessions by the School-Based Health Alliance revealed substantial innovation and expansion of telehealth services. Providers and sponsoring organizations shared challenges and mechanisms for troubleshooting barriers during online webinars to provide support, education, and resources to SBHCs. Lessons learned during the COVID-19 pandemic demonstrate the value of SBHCs, which continue to target barriers to health care access, protect the most vulnerable, and decrease the spread of disease. Telehealth implementation by SBHCs can support schools and communities, mitigate future strain on the health care system by continuing to keep youth from over-burdened emergency departments and provide needed mental health care. State and federal policy changes can ensure the continued provision of telehealth by SBHCs for disadvantaged youth.

A Midwestern Academic HIV Clinic Operation during the COVID-19 Pandemic: Implementation Strategy and Preliminary Outcomes.

During the COVID-19 pandemic, HIV clinics had to transform care delivery for people with HIV (PWH). We developed a multifaceted telehealth implementation strategy and monitored number of out of care patients (OOC), medical visit frequency (MVF), gap in care (GiC) and viral suppression (VS), and compared measures to baseline data. Between April and October 2020, 1559 visits were scheduled; 328 (21%) were missed, and 63 (4%) were new to care. Of the remaining 1168 follow-up visits, 412 (35%) were telehealth visits. As of October 2020, there were 53 patients OOC, MVF was 55% and GiC was 24% compared to 34, 69% and 14% at baseline, respectively. Overall VS rate remained high at 93% (97% for telehealth and 91% for in-person visits, p = 0.0001). Our implementation strategy facilitated quick provision of telehealth to a third of PWH receiving care in our clinic. While MVF decreased and GiC increased, VS rates remained high.

General practitioner knowledge of and engagement with telehealth-at-home medical abortion provision.

In Australia, there are many barriers to abortion, particularly for women living in regional, rural and remote areas. Telehealth provision of medical abortion is safe, effective and acceptable to patients and providers. In 2015, Marie Stopes Australia (MSA) launched an at-home telehealth model for medical abortion to which GPs could refer. Between April and November of 2017, we interviewed 20 GPs who referred patients to MSA's telehealth-at-home abortion service to better understand their experiences and perspectives regarding telehealth-at-home abortion. We found that there was widespread support and recognition of the benefits of telehealth-at-home abortion in increasing access to abortion and reducing travel and costs. However, the GPs interviewed lacked knowledge and understanding of the processes involved in medical abortion, and many were unaware of the availability of telehealth as an option until a patient requested a referral. The GPs interviewed called for increased communication between telehealth-at-home abortion providers and GPs. Increasing GP familiarity with medical abortion and awareness of the availability of telehealth-at-home abortion may assist people in accessing safe, effective medical abortion.

Bridging the digital divide for vulnerable patient telehealth

In New Orleans, Louisiana, 61% of advanced age patients have low health literacy, 50% report financial insecurity, and more than one-third have high hospital readmission rates and medical complexity scores. This population has been disproportionately impacted by the COVID-19 pandemic and the system-wide transition to remote, virtual visits. While COVID-19 has accelerated needs for impactful remote care and research, this has been impeded by low telehealth literacy and structural barriers, such as lack of internet and devices. There are major gaps in the literature regarding telemedicine services in geriatric and complex populations and efficacy rates are variable in these populations. There is currently no telehealth literacy screening tool designed for identifying patients with barriers requiring additional interventions to succeed, no uniform understanding of the factors affecting use or how to increase engagement, and telehealth models requiring fluent use of technology for older adults have been met with poor rates of completed visits and associated harm. Following a dedicated 358.5 hours to training 309 geriatric, complex patients in telemedicine using our pre-existing telehealth model, averaging 4.78 hours per patient, only 18.8% of these patients were subsequently able to connect to the provider virtually. Here we describe lessons learned and tools developed from the Ochsner MedVantage Network Innovation project, including the development of a telehealth literacy screening tool, the adaptation and provision of simplified, user-friendly tablets, and a randomized control trial to determine if increased accessibility to telehealth leads to improved healthcare outcomes, such as decreased hospital admissions and emergency department utilization.

Australian private practice metropolitan telepsychiatry during the COVID-19 pandemic: analysis of Quarter-2, 2020 usage of new MBS-telehealth item psychiatrist services.

Objective:The Australian Commonwealth Government introduced new psychiatrist Medicare-Benefits-Schedule (MBS)-telehealth items in the first wave of the COVID-19 pandemic to assist with previously office-based psychiatric practice. We investigate private psychiatrists’ uptake of (1) video- and telephone-telehealth consultations for Quarter-2 (April–June) of 2020 and (2) total telehealth and face-to-face consultations in Quarter-2, 2020 in comparison to Quarter-2, 2019 for Australia.Methods:MBS item service data were extracted for COVID-19-psychiatrist-video- and telephone-telehealth item numbers and compared with a baseline of the Quarter-2, 2019 (April–June 2019) of face-to-face consultations for the whole of Australia.Results:Combined telehealth and face-to-face psychiatry consultations rose during the first wave of the pandemic in Quarter-2, 2020 by 14% compared to Quarter-2, 2019 and telehealth was approximately half of this total. Face-to-face consultations in 2020 comprised only 56% of the comparative Quarter-2, 2019 consultations. Most telehealth provision was by telephone for short consultations of ⩽15–30 min. Video consultations comprised 38% of the total telehealth provision (for new patient assessments and longer consultations).Conclusions:There has been a flexible, rapid response to patient demand by private psychiatrists using the new COVID-19-MBS-telehealth items for Quarter-2, 2020, and in the context of decreased face-to-face consultations, ongoing telehealth is essential.

English

The rapid spread of Coronavirus disease (COVID-19) has led to global pandemic affecting mental and physical well-being of people around the world. Given the highly contagious nature of COVID-19, public authorities in order to restrict the escalation of the virus ordered social lockdown and asked people to self-quarantine at homes if they develop any symptoms. As a result, these new social regulations have changed how individuals live and carry out everyday tasks in the general society. Reduced physical activity during lockdown has enhanced vulnerability to develop infections and non-communicable diseases. While on the other side, due to absence of routine medical surveillance, the condition of people with existing chronic conditions has deteriorated. Re-allocation of health care resources to treat COVID-19 patients put forward unprecedented challenge for the healthcare system in terms of providing medical support to non-infected out-patients. Extended social lockdowns are also causing adverse repercussions for physiotherapy and rehabilitation out-patient services. COVID-19 restrictions have hampered the in-person interaction of therapists and patients for in-person consultations and therapy sessions. Thus, leading to overall delay in the management and recovery of patients, especially those who are at a critical stage of treatment. During these unprecedented times of COVID19 pandemic, provision of telehealth appeared to be the guiding light to tackle these evolving challenges of public health. Focusing on the out-patients who need close supervision for therapies and counselling, in this piece, “I” am arguing that methods of telemedicine and tele-rehabilitation should be actively adopted in the healthcare services to bridge the gap caused due to COVID-19.