Telehealth Services Research Articles

Associations Between State Policies Facilitating Telehealth and Buprenorphine Episode Initiation and Duration Early in the COVID Pandemic : State Telehealth Policies and Buprenorphine.

State policies facilitating telehealth implemented early in COVID may support buprenorphine treatment of opioid use disorder. However, little empirical information is available about those policies' effects. Examine association between state policies that may facilitate telehealth use and buprenorphine treatment. Retrospective cohort study using 2019-2020 national pharmacy data on dispensed buprenorphine prescriptions. State policies implemented after March 3, 2020, public health emergency declaration requiring private insurers' telehealth reimbursement to be commensurate with in-person service reimbursement, authorizing Medicaid reimbursement for audio-only telehealth, allowing physicians to provide cross-state telehealth services, and allowing psychologists to provide cross-state telehealth services. (a) Duration of treatment episodes started between March 1 and March 13 in both 2019 and 2020, and (b) daily numbers of new buprenorphine treatment episodes from March 13 through December 31 in each year. We found little change in the number of new buprenorphine treatment episodes started in 2020 compared to 2019 and an increase in treatment duration of 10.3days (95%CI 8.3 to 12.2days) for episodes started in March 2020 before the public health emergency declaration compared to the comparable 2019 period. States implementing a telehealth parity policy in 2020 had 7.3% (95%CI - 13.3% to - 0.4%) fewer new buprenorphine treatment episodes. States joining the psychologist interstate compact in 2020 after the public health emergency declaration had treatment episodes 7.97days longer (95%CI 0.78 to 15.16) than other states. None of the other policies examined was associated with changes in new treatment episodes or treatment duration. Policies undertaken during the pandemic we examined were associated with few significant changes in buprenorphine treatment initiation and duration. Findings suggest realizing the benefits of telehealth and other policy changes for buprenorphine may require more extensive implementation and infrastructure support.

First Nations Peoples' perspectives on telehealth physiotherapy: a qualitative study focused on the therapeutic relationship.

Relationships are the core of Indigenous Peoples' spiritual and cultural identities, and therapeutic relationships are an integral part of the physical rehabilitation process, directly influencing health outcomes. However, participating in therapeutic relationships can be difficult for First Nations Peoples, particularly in the virtual landscape. There is limited understanding of First Nations Peoples' perspectives on this issue, and this understanding is crucial to developing culturally safe and effective telehealth physiotherapy programs. Therefore, the purpose of this study is to explore the perspectives of First Nations Peoples from British Columbia, Canada, on telehealth physiotherapy, with an emphasis on the virtual therapeutic relationship. A narrative qualitative study that utilized one-on-one, semistructured interviews was conducted with 19 First Nations adults from remote and rural First Nations communities in north-central British Columbia, Canada. Interviews were recorded, transcribed verbatim, and analyzed using an inductive approach to reflexive thematic analysis. Three themes emerged from data analysis. 'Therapist's attitude and rapport' captures participants' perceptions of what matters the most in how physiotherapists relate to First Nations Peoples and carry out their work. 'Remote nature of virtual care' encompasses the main challenges of virtual care visits, particularly how these were perceived to impact establishing and maintaining solid therapeutic relationships. 'Fostering culturally appropriate and safe telehealth physiotherapy' focuses on what is needed to advance telehealth physiotherapy in a manner that respects and reflects First Nations cultures, equipping all involved parties to provide comprehensive and sensitive services. Our findings advocate a hybrid model that combines in-person and telehealth visits to address communication barriers and the absence of physical interaction. Bridging the digital health literacy gap through training and collaboration with local support staff is crucial (as it is to bridge the possible cultural literary gap of therapists), and the incorporation of cultural elements holds promise for enhancing the engagement and effectiveness of telehealth services in these communities. The pursuit of equitable health care for First Nations communities demands not only increased access but also a thoughtful, culturally safe, trauma-informed, and holistic approach. This approach must be tailored to the unique needs of First Nations Peoples, emphasizing the integration of cultural elements and community support. A hybrid model combining in-person and telehealth visits is recommended to address logistical challenges and enhance the therapeutic relationship, ensuring that care is both effective and respectful of cultural values and practices.

Suicide prevention via telemental health services: insights from a randomized control trial of crisis response plan and self-guided safety planning approaches.

Although telemental health can make suicide prevention treatments more scalable and accessible, limited evidence demonstrates successful reductions in suicidality when interventions are administered through telehealth platforms. To address this limitation, the current work investigated the effects of two suicide prevention treatments - a clinician-guided Crisis Response Plan and a self-guided Safety Planning approach. After completing the screening process, 82 participants with high suicide ideation and/or a lifetime history of suicidal behavior were randomly assigned across the two groups. Trained research clinicians administered the interventions using a videoconferencing platform. After the intervention delivery was complete, participants reported the therapeutic alliance they experienced with their clinician using an online survey. Participants also reported their overall suicidality 45 days after receiving the intervention. In addition, participants' perceived usefulness of the received intervention and actual use of the plan were recorded. Linear and logistic regression models predicted how suicidality, perceived utility, and actual use of their intervention protocols varied depending on the high (Crisis Response Plan) versus low (self-guided Safety Planning) level of clinician-led collaboration the two treatments entailed. Both Crisis Response Plan and self-guided Safety Planning were found to lower suicidality after receiving them via telehealth services. At the same time, those who received the Crisis Response Plan (the more collaborative form of therapy) reported experiencing a stronger therapeutic alliance with the clinician, utilizing the plan more often and perceiving it as more useful. These findings demonstrate the additional benefits of adopting a more collaborative approach because of its effectiveness and perceived utility, which has implications for suicide-related distress reduction in the short and long term. Evidence from this randomized control trial suggests that Crisis Response Plan is a suitable candidate for delivering suicide prevention via telehealth platform because of its effectiveness in reducing suicidality and its collaborative approach to building a strong therapeutic alliance, perceived usefulness, and actual utility in everyday life. This paper was part of a registered RCT: https://clinicaltrials.gov/study/NCT04888845 . Registration date: Date: 2021-04-22.

Abstract 4126893: Feasibility and Acceptability of a Nurse-Pharmacist Post-Discharge Telehealth Model of Care for Heart Failure Patients

Background: Suboptimal medication management is common in patients with heart failure (HF), particularly during transitions-of-care. To date, there are few studies assessing the feasibility of a nurse-pharmacist post-discharge telehealth service for medication optimisation in patients with HF. We performed a feasibility study to determine service uptake and acceptability, and ability to identify medication-related issues for HF patients as they transition from hospital to home. Methods: HF patients were referred to an existing post-discharge telehealth service and offered medication reconciliation and education in addition to their usual care; a service we termed ‘MedRec’ (MR). Primary outcomes were feasibility, measured through recruitment and successful MR completion, and acceptability, measured by an investigator-developed survey. Secondary outcomes were medication-related issues detected during MR. Results: A total of 100 HF patients were offered a post-discharge MR. Mean age of patients was 68.5 ±14.2 years, and mostly male sex (62%). Pharmacist MRs were requested by 80% of patients. In total 62 MRs (77.5%) were performed; 9 patients declined MR during follow-up and an additional 9 patients were uncontactable. Mean time to MR following nurse referral was 10.98 ±9.74 days. Drug-related toxicity or adverse effect presentation was identified in 25 (40.3%) MR recipients at the time of consultation and subsequently required general practitioner follow-up. Medication compliance issues were detected by the pharmacist in 13 (20.9%) patients; forgotten doses being the most common concern. Undertreated medical conditions, such as symptomatic HF and chronic pain, were identified in 12 (19.3%) MR recipients. Medications prescribed without any apparent indication were found in 8 (12.9%) patients. Drug or disease management information was requested by 35 (56.4%) MR recipients. A total of 35 (56.5%) post-MR surveys were successfully completed. All participants who completed a post-MR survey agreed that a post-discharge telehealth MR was an acceptable form of education provision. Engagement with a pharmacist MR was perceived to ease anxiety associated with understanding medication-related changes and empowered greater medication self-management. Conclusions: A post-discharge nurse-pharmacist telehealth service is a feasible and acceptable model of care. Inclusion of a routine MR post-discharge may be an effective means of maintaining continuity of care for HF patients.

Telehealth Use and Legal Considerations in Drug Health Services During Pandemics: Systematic Scoping Review.

The COVID-19 pandemic impacted patients with substance use disorder (SUD) more than the general population and resulted in substantially increased emergency department admissions. Routine care of patients attending drug health services during the pandemic transitioned, with telehealth being important in delivering appropriate care. However, telehealth introduces unique risks such as privacy, confidentiality, and data safety. Providing health care through telehealth may fail if the legal impacts are not fully identified and acted on by health professionals. It also poses unintended risks for patients and can result in ineffectiveness, damages, medical negligence, and detracts from the best intentions of governments and health professionals. Understanding the legal framework ensures that medical professionals operate health care through telehealth within the law. Providing health care successfully through telehealth depends on the balance between innovation and legal compliance. By considering these aspects, clinicians and practitioners can provide effective and safe telehealth services during pandemics or any other natural disaster. We aimed to explore the legal impact of autonomy consent, confidentiality, privacy, data security, professional indemnity, and liability when delivering telehealth to patients with SUD. The scoping review also aimed to provide legal, ethical, and clinical considerations to minimize legal risks with using telehealth in drug health service outpatient settings. We performed a scoping review to provide an overview of existing research, statutes, and case laws for the incorporation of clinical, ethical, and legal considerations into telehealth use. Six databases for medical and 6 databases for legal publications were searched, as well as Australian national and selected international regulatory standards. Medical articles published up to June 2022 were included in this review. Our search yielded 1436 publications, 614 abstracts were reviewed, and 80 published studies met the inclusion criteria from 614 legal and medical search results. Current regulations related to technology use in drug health services, relevant cases, and international regulatory standards are discussed. In total, 43 legal documents including 15 statutes, 4 case laws, and 37 medical publications were reviewed. The themes arising from the literature were consent and autonomy (20/80, 25%), confidentiality (8/80, 10%), privacy (8/80, 10%), data security (7/80, 9%), and professional indemnity issues (3/80, 4%) in telehealth use. Further, 24 studies identified legal issues associated with telehealth use in patients with SUD. Our review identified potential legal issues associated with telehealth use in patients with SUD. Several legal and medical research articles provide frameworks, codes of conduct, or suggestions for clinicians to consider, but there was little discussion or evidence of how legal considerations are being applied when providing telehealth consultations at drug health services. Clinicians should be aware of the medicolegal implications when providing health care via telehealth at drug health services.

Community-Level Internet Connectivity and Utilization of Maternal Telehealth.

Background: The COVID-19 pandemic brought about a drastic increase in the utilization of telehealth services in place of or as a complement to in-person health services. Telehealth is a tool to help reduce disparities in the receipt of maternal health care. However, a stable internet connection is required for patients to connect to providers via telehealth; lack of internet connectivity is a barrier to maternal telehealth access. Methods: The objectives of this research were to determine whether community-level internet penetration is associated with community-level utilization of maternal telehealth services and assess the heterogeneity of this association across the maternal telehealth utilization spectrum. A cross-sectional study of community-level maternal telehealth is utilized in the United States in 2019. The underlying population is comprised of commercially insured maternal health patients receiving any antenatal, delivery-related, or postpartum care in the United States. The individual-level utilization data are aggregated to the geo-zip level (n = 404), which is a regional subdivision comprised of all zip codes that share the first three digits. Results: Findings show that the estimated relationship between the proportion of households with home-based internet connectivity was statistically significant at the 10th and 25th quantiles of maternal telehealth utilization. For these quantiles, an increase in community-level internet connectivity was associated with an increase in the utilization of maternal telehealth services. Conclusion: There is a positive association between community-level internet connectivity and maternal telehealth utilization, and the association varies in magnitude across the maternal telehealth utilization distribution. Policymakers should consider digital access when addressing telehealth policy for maternal care services.

Telehealth Research Strategies in a Post COVID-19 Era: A Roadmap for the Coming Decade.

An Agency for Healthcare Research and Quality-funded Think Tank, held at Michigan State University, brought together a wide range of subject matter experts in telemedicine, telehealth, digital health, digital access, and health care. The authors of this article represented a group focused on the research needs, constructs, and strategies in the post-COVID era. While telemedicine and telehealth grew exponentially during the pandemic, the challenges that have been with us for decades, while ameliorated to some extent, remain. To showcase the State of Michigan as a model, the authors reviewed challenges and opportunities related to telehealth and telemedicine usage and categorized them into seven areas of highest priority. Based on a review of the literature and consultation in the fields of telehealth, telemedicine, and digital access, we identified seven key categories where research would be most effective going forward. These categories include research into the impact of telehealth on clinical services, telehealth's use in administrative activities, education and training for health care providers and patients, telehealth policy implications at state and federal levels, the impact of future technology and innovation on telehealth services, patient characteristics and their experiences, and the ethical aspects of telehealth in the future. We have formulated this overview of our findings to act as a roadmap for future telehealth research. We recommend that ongoing studies should explore each of the seven categories identified above. The search for solutions to overcome the challenges within these topics must not be constrained to research that has been conducted recently; many of these challenges have faced telehealth researchers for decades, and numerous solutions have been proposed over the years. Some of these proposals should be explored once again in light of technological and societal advances. The findings from these studies should be shared in ways and through venues that can make them accessible outside the spheres of academic research, but also by practitioners, policymakers, and patients. Third, research into telehealth in all its incarnations must be prioritized, and leadership is needed to ensure these areas of study are continued to be spotlighted after the noise of the COVID-19 pandemic grows quiet.

DISP-13. TELEHEALTH UTILIZATION IN NEURO-ONCOLOGY: EXPERIENCE AFTER THE COVID-19 PANDEMIC

Abstract BACKGROUND Central nervous system (CNS) tumors are frequently characterized by physical disabilities, and treatment is often associated with side effects, as well as financial toxicity and loss of income owing to disease-related neurological deficits. Treatment at centers with specialized neuro-oncology care is associated with an overall survival benefit. However, access to such centers can be limited for many patients. Telehealth services represent an option for improving access to specialized care. During the COVID-19 pandemic public health emergency (PHE), regulatory and reimbursement changes provided patients improved access to neuro-oncology by telehealth. METHODS We retrospectively analyzed our institutional utilization of telehealth visits in the neuro-oncology vs solid tumor oncology practice after the COVID-19 pandemic. RESULTS Between July 2020 and April 2021, telehealth represented 24.1% of all neuro-oncology visits compared to 13.3% for all solid tumor groups. Between May 2021 and April 2023, telehealth visits remained frequent in neuro-oncology compared to solid tumor groups (34.6% vs 15.2%). Utilization rates declined across the practice in the year following expiration of the COVID-19 PHE in May 2023, though remained high for neuro-oncology at 34.1% vs 15.2% for solid tumor groups. Overall, telehealth visit utilization for neuro-oncology has remained more than double that of the oncology practice as a whole. CONCLUSIONS The striking difference between telehealth visit utilization in neuro-oncology compared with general medical oncology indicates that patients with CNS tumors, and those that provide care for these patients, have come to depend on this mode of care delivery. Even after expiration of the COVID-19 PHE, telehealth use remains high in neuro-oncology at our institution. Prospective evaluation to determine the safety of and clinical outcomes associated with telehealth visits for individuals with CNS tumors are critically needed. Such data may promote regulatory and reimbursement reform enabling broader adoption, service sustainability, and improved access to specialized care.

Telehealth delivery of GenerationPMTO in the public mental health system: A pragmatic, noninferiority study.

Telehealth is a promising means for expanding access to mental health treatment. Yet, more research is needed to ensure that telehealth service delivery is no less effective than in-person treatment in real-world service delivery contexts. In the current study, we compared telehealth delivery of the GenerationPMTO parenting intervention to in-person delivery in the context of the public mental health system. Using a noninferiority approach with a sample of n = 1452 caregivers, we found telehealth delivery to be noninferior to in-person delivery on all caregiver outcomes: parenting practices, parenting confidence, and caregiver depressive symptoms. We were unable to conclude that telehealth delivery was noninferior to in-person delivery for child behavior problems. Our findings add to the literature suggesting the utility of using telehealth to provide services to families-particularly for delivering evidence-based parenting interventions to enhance caregiver outcomes. Implications for couple and family therapy are discussed.

Pilot Trial of a Speech-Language Pathology Telehealth Service to Enhance Postdischarge Dysphagia Care in Singapore.

Patients and caregivers in Singapore experience issues managing dysphagia care at home following hospital discharge, and they prioritized improving access to postdischarge dysphagia care and support. Hence, a postdischarge dysphagia telehealth service was developed. This study aimed to evaluate the feasibility of this service by examining patient and service outcomes, preliminary costs, and consumer satisfaction. Patients with dysphagia and their caregivers attended one or more telehealth sessions over the initial month post-hospital discharge. Reviews of dietary adherence and preparation, swallowing function, and therapy progress were conducted. If needed, clinical support and intervention were provided. Data related to patient and service outcomes, preliminary costs, and consumer satisfaction were collected and analyzed using descriptive statistics and content analysis. Twenty patients attended 42 telehealth sessions. No support was provided during 10 sessions, minor support was provided during 13 sessions, and major support and intervention were provided to address patient and swallowing safety during 19 sessions. Out of 20 patients, 19 required support and intervention during the first week postdischarge, but they experienced fewer issues with each subsequent session. They were highly satisfied with the service. The average session duration was 29.6 min. No sessions were cancelled. This service can be delivered with minimal additional health service resources and at a low cost to consumers. This service is feasible, cost-effective, and well accepted by consumers. It facilitates early identification and management of swallowing and patient safety during the initial month post-hospital discharge. Wider implementation of this service model should be considered. https://doi.org/10.23641/asha.27327345.

Telehealth Challenges, Opportunities, and Policy Recommendations for Rural Older Adults Living with HIV in the United States

ABSTRACT Over one million people in the United States (U.S.) are living with HIV. People living with HIV in the rural South experience delayed HIV treatment and increased mortality risks. Access challenges and HIV stigma exacerbate care disengagement for rural people living with HIV (PLH). This study examines the applicability and feasibility of telehealth to provide HIV care for older adults in the rural U.S. South. Semi-structured interviews were conducted with 27 key informants with expertise in HIV care and community engagement in high rural HIV burden states. Results indicate that telehealth challenges exist for older rural PLH to receive HIV care, such as lack of internet access and low technology literacy. Phone calls can be a simple and effective telehealth option for older rural PLH, as they align with their care preferences, mitigate care barriers, and show promise increasing care engagement. When warranted, complex telehealth options for older rural PLH require tailored approaches, such as portable medical instruments allowing real-time data sharing during home visits or tablet distribution from the clinic. Findings suggest that policy makers and providers support the reimbursement and use of audio-only telehealth services, expand broadband infrastructure and affordability in rural areas, and implement tailored telehealth interventions.

Roles Caregivers Take on in Pediatric Rehabilitation Telehealth Services: A Scoping Review.

Caregivers and children continue to use pediatric rehabilitation telehealth services (PRTS) post-pandemic. Understanding how caregivers support children during PRTS can help us fully integrate caregivers for positive outcomes. This scoping review describes the roles caregivers take on during PRTS. We searched MEDLINE, CINAHL, PsycINFO, and ERIC for research published January 2005 to July 2023. We included English articles on the effect of PRTS. We excluded qualitative and non-peer-reviewed literature. Thirty-four articles met inclusion criteria. Caregivers were gatekeepers, technicians, implementers, trainees, collaborators, telehealth consumers, and supervisors in PRTS. Caregivers took on roles throughout PRTS, and roles varied by type of PRTS delivered. Caregivers take on multiple roles to support children during PRTS. Our results can inform clinical decisions about how to integrate and support caregivers in PRTS. Future research should explore strategies that support caregiver role taking to maximize caregiver involvement and outcomes in PRTS.

Evaluating the Efficacy of Telehealth-Based Treatments for Depression in Adults: A Rapid Review and Meta-Analysis.

Major depressive disorder (MDD) is one of the leading causes of work-related disability, and accessing telehealth therapies can be a promising modality for workers with MDD. Barriers to accessing in-person mental healthcare, such as limited availability and accessibility in rural and remote communities, financial constraints, and stigma, have highlighted the need for alternative approaches like telehealth. This study investigated the efficacy of telehealth interventions including CBT for adults over 18 diagnosed with MDD. This rapid review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to ensure a transparent methodology. Out of the 2549 studies screened, 19 were incorporated into the rapid review, and of those, 10 were included in the subsequent meta-analyses. Articles were screened independently by two reviewers, with the disagreements reconciled through discussion. A reviewer extracted data from eligible articles. Descriptive statistics and narrative syntheses were used to describe outcomes. Two meta-analyses were conducted to investigate the efficacy of cognitive behavioral therapy (CBT) delivered by telehealth (tCBT). The first compared tCBT to in-person CBT (pCBT). The second meta-analysis compared tCBT to a control group that did not receive CBT or another telehealth-based treatment. Non-CBT interventions investigated within the non-CBT group included somatic rhythm therapy, problem-solving therapy, psychiatry, behavioral activation, and interpersonal psychotherapy. Overall, individuals with MDD who received tCBT showed significant improvement in depression symptoms. However, the efficacy of tCBT compared to non-telehealth control groups varied across studies. The first meta-analysis indicated the magnitudes of effect were similar for both interventions in reducing depression symptoms 0.023 (95% CI -0.120 to 0.166); p = 1.00. In the second meta-analysis, the ratio of means comparing tCBT (0.51 ± 0.14 SD) to the control group (0.68 ± 0.12 SD) exhibited a statistically significant 25% reduction with regard to depression scores (one-sided p = 0.002), favouring tCBT to non-telehealth, non-CBT study groups. Telehealth-based CBT demonstrated positive effects on depression symptoms; it was generally superior when compared to control groups not receiving CBT and was on par with pCBT. The growing mental health burden in the community underscores the need for accessible telehealth services like tCBT. Effective policy formulation and implementation in national health agendas are essential to meet the increasing demand for mental health support.

Impact of Home Telehealth Expansion on High-Cost Utilization Among Veterans Health Administration Patients with Diabetes.

Home telehealth (HT) services have rapidly expanded in the Veterans Health Administration (VHA), but little is known about the real-world impact of the expansion of these services on utilization. To evaluate the impact of expanding HT diabetes services in VHA on high-cost utilization. This cohort study used cross-temporal propensity score matching to identify patients with diabetes who would receive HT services (treatment group) with program expansion (treatment group) with a comparison group of patients with diabetes who did not receive HT services (control group) between 2010 and 2018. A difference-in-differences design was used to compare pre-post changes in high-cost utilization between propensity-matched groups. Data used was from the VHA's Corporate Data Warehouse. VHA patients with diabetes, n=7214 in the treatment group who received HT services, and n=1,067,138 in the control group who did not receive HT services. Emergency department (ED) visits, all-cause hospitalization, and hospitalizations for ambulatory care sensitive conditions (ACSCs). In the baseline period, patients in our sample had a mean age of 67 years old (SD=11 years), were 97% male, and 78% had a hemoglobin A1c (HbA1c) < 8%. The increase in HT use was associated with a net increase of ED visits per patient (0.215 95% CI [0.152, 0.279]), all-cause hospitalization (0.053 95% CI [0.032, 0.074]), and ACSC hospitalization (0.032 95% CI [0.019, 0.045]). Expanding HT or remote monitoring services may lead to additional needs being identified for patients, including increased access to in-person care, such as ED or hospital services.

Telephone Survey-Reported Perceptions of Telehealth Visits Among Black and Non-Black Patients Diagnosed With Cancer.

Empirical evidence underscores both benefits of telehealth visits and persistent disparities in use for Black adults. Guided by the Technology Acceptance Model, we evaluated perceptions regarding telehealth visits among Black and Non-Black adults receiving cancer care from two academic health systems. Between April 2022 and October 2023, a survey was conducted among adult patients treated for cancer in the past 3 years. Survey recruitment was stratified by visit type (telehealth or in-person) and race. Before a scheduled oncology visit, respondents completed a telephone survey to assess their perceptions of usefulness, ease of use, and attitudes toward telehealth visits. Frequency differences were estimated using chi-square tests, and prevalence differences using logistic regression. The survey was completed by 773 respondents (42% Black) with a 15% response rate. Black respondents were younger and less likely to report male sex, being married, having a college education, comfortable income, or confidence in medical and e-literacy. Compared with Non-Black respondents, Black respondents perceived telehealth visits as less useful for determining health needs (37% v 48%) and asking questions (9% v 15%). They thought that telehealth visits were less easy with regard to understanding their health care provider (14% v 21%) and the ability to connect (23% v 30%). Black respondents expressed more concern about internet access (26% v 15%), access to electronic devices (17% v 9%), and finding assistance for connecting (24% v 12%). They also found telehealth visits to be less private (19% v 34%). Racial differences in telehealth ease of use and usefulness perceptions highlight the need for oncology practices to couple connectivity support with effective communication strategies to avoid disparities in oncology telehealth services.

Evaluation of Pharmacist-led Telehealth Medicare Annual Wellness Visits to Satisfy Quality Metrics and USPSTF Recommendations After Implementation of a Post-Visit Follow-Up Protocol.

Background: A Medicare Annual Wellness Visit (MAWV) serves Medicare patients by identifying and addressing gaps in preventive services and health screenings, often aligning with outpatient practice quality metrics. Objective: Evaluate an existing pharmacist-led MAWV telehealth service, determine the baseline quality metric satisfaction rate of telehealth MAWVs, and assess for improvement after implementing a post-MAWV follow-up protocol at a suburban, lower-income primary care clinic. Methods: This IRB-exempt, single-center retrospective chart review utilized the electronic health record at Christ Health Center, Birmingham, AL. From August 2020 through May 2022, 288 charts were assessed between 2 retrospective chart reviews that included patients 18 years or older with Medicare insurance and the ability to conduct a telehealth MAWV. The first chart review assessed metric and recommendation satisfaction within 12months of the visit. The second chart review was performed after follow-up protocol implementation to assess for additional improvement within 3 months of the visit. Results: The percentage of MAWV recommendations completed groups after implementing a follow-up protocol. For the first chart review, 57.1% of the assessed Health Resources and Services Administration (HRSA), Uniform Data System (UDS) quality metrics, and Centers for Medicare and Medicaid Services (CMS)-required MAWV components were satisfied from the first chart review compared to 53.3% of satisfied quality metrics post-protocol implementation in spite of a substantially shorter follow-up timeframe. Conclusion: Telehealth MAWVs improve preventive care and quality metric satisfaction for Medicare patients. Post-visit follow-up protocols enhance satisfaction rates. Pharmacist-led MAWVs foster interprofessional collaboration and comprehensive patient care.

Adoption and Utilization of Telemedicine and Digital Health Services among Older Adults in Israel

Abstract Background As the population ages and the prevalence of long-term diseases rises, telecare is being used increasingly frequently to aid elderly people. Aims We aimed to explore the usage and adoption of 3 types of telehealth services among the senior population in Israel- prior, during, and after the COVID-19 pandemic rise in Israel. Methods We explored the usage characteristics of older adults (age 65 and above) belonging to ‘Clalit’, in the use of three types of telehealth services: digital services for administrative tasks, synchronous ‘online visits’ with the patient’s personal physician during clinic business hours, and ‘afterhours’ consultations during evenings, nights, and weekends. The data was collected and analyzed throughout three distinct time periods in Israel: before the COVID-19 pandemic, during the onset of the COVID-19 pandemic and following the COVID-19 ‘peak’. Results Data of 618850 patients who met the inclusion criteria was extracted. Telehealth services utilized for administrative purposes were the most popular. The older population significantly increased their use of all types of telehealth services during the COVID-19 period, and in the majority of types, this usage decreased after the COVID-19 peak, but to a level that was higher than the baseline level prior to the COVID-19 period. Prior to the COVID-19 period, 23.1% of the study population used ‘online visits’, and 2.2% used ‘afterhours’ consultations, at least once. The percentage of usage for these services increased during the COVID-19 period to 59.2% and 5.0%, and then decreased during the third period to 39.5% and 2.4%, respectively (P &amp;lt; 0.001). Multiple patient variables have been found to be associated with the use of the different telehealth services, in each time-period. Conclusions The senior population uses telehealth services, and can increase their consumption, when they are needed. Suitable and straightforward telehealth solutions tailored for this population should be created. Key messages • The senior population uses telehealth services, and can increase their consumption, when they are needed. • Suitable and straightforward telehealth solutions tailored for this population should be created.

Navigating the Post-Dobbs Landscape: A Roadmap for Interstate Abortion Care

n June 2022, the Supreme Court issued an unprecedented ruling in the case of Dobbs v. Jackson, revoking the constitutional right to abortion for the first time in 50 years. To date, fourteen U.S. states have completely banned abortion. Consequently, individuals residing in states with restrictive legislation are forced to travel to neighboring states to access abortion care and other reproductive services. Extended travel time disproportionately affects individuals from communities of color, low-income patients, and rural residents, increasing the risk for maternal health complications and death. The United States holds the highest maternal mortality rate among developed nations, with 33 deaths per 100,000 births (Katella 2023). Alarmingly, 84% of these deaths are considered preventable (Katella 2023). Thus, it is imperative that state healthcare policymakers prioritize equitable access to comprehensive reproductive healthcare for all patients (Katella 2023). This care should incorporate strategies to decrease on-site patient volume, such as implementing shield laws to protect abortion providers treating out-of-state patients, enhancing telehealth services for abortion medication services, and incentivizing the establishment of physical infrastructure. For state officials in destination states, specifically the 23 governors of the non-partisan Reproductive Freedom Alliance, we recommend immediately prioritizing the establishment and anticipated enforcement of provider shield laws. To ensure widespread and equitable access to reproductive healthcare services, a more robust three-tiered approach is outlined herein, prioritizing: (1) shield laws, (2) telehealth services, and (3) physical infrastructure.

Digital Health Interventions’ Impact on Health Literacy: A Systematic Review

Abstract In the digital era, health literacy is crucial for informed health decisions and outcomes. This systematic review evaluates the effectiveness of digital health interventions (DHIs) in enhancing health literacy, as defined by the World Health Organization. We included a variety of studies, such as cross-sectional studies, surveys, and case reports, focusing on interventions like mobile health apps, online platforms, and telehealth services. Our search, adhering to PRISMA guidelines, spanned databases like PubMed, IEEE, and ACM, covering publications from 2013 to 2023. From 1,029 initial articles, 58 met our inclusion criteria after rigorous screening and duplicates removal. Our findings highlight that DHIs, including multimedia tools and remote sessions, significantly bolster health literacy across diverse populations. However, the impact varies due to the digital divide, influenced by factors like age and socioeconomic status. This review underscores the potential of DHIs in public health and the necessity to address accessibility to reduce health disparities. The full synthesis of data and methodological details will be discussed in the presentation, aiming to guide future digital health strategies and policies. Key messages • Digital Interventions Enhance Health Literacy Across Diverse Populations. • Addressing the Digital Divide to Ensure Equitable Access to Health Benefits.

Barriers and challenges to telemedicine usage among the elderly population in Israel

Abstract Background Despite the challenges to its adoption, telemedicine is becoming more and more popular for helping elderly people preserve their independence and continue to live in their own homes. Aims We investigated the challenges and barriers experienced by the elderly population when using telemedicine services in Israel. Methods Fourteen elderly people were recruited for the study and interviewed in person using a semi structured interview protocol, using a qualitative technique. Participants’ replies were evaluated and analyzed thematically. The participants were questioned regarding their usage of telehealth services, the benefits they perceive in them, any potential difficulties to use, and suggestions they had for making these services more readily available and simpler to use for the elderly. Results Most participants recognized the advantages of telehealth services, particularly for the elderly population during pandemics and normal times. However, most of them also expressed various challenges that face the elderly population in using these services. Many participants were concerned that the quality of telemedicine sessions may not be good enough compared to in-person sessions, and expressed a lack of confidence in telemedicine services, and frustration from the absence of in person interaction. Many participants highlighted the technological challenges in the use of computers and applications in general and in the context of healthcare, in particular, in addition to physiological and literacy difficulties. Finally, the participants suggested several ways to increase the accessibility and usage of telemedicine solutions by elderly people. Conclusions A proactive approach to identifying and resolving telehealth barriers can maximize virtual interactions for the older population and alleviate care inequities. There is a need to increase awareness of the availability, benefits, and uses of each telehealth service in comparison to in-person consultations. Key messages • A proactive approach to identifying and resolving telehealth barriers can maximize virtual interactions for the older population and alleviate care inequities. • There is a need to increase awareness of the availability, benefits, and uses of each telehealth service in comparison to in-person consultations.