Telehealth Usage Research Articles

Telehealth Sustainability in a Neurosurgery Department During the COVID-19 Pandemic

BackgroundThe COVID-19 pandemic has shifted the dynamics of health care and neurosurgical practice. Elective surgeries were suspended for 8 weeks in Kentucky. Our objective was to determine if telehealth (TH) visits could be sustained as an alternative to in-person visits.MethodsDeidentified data on TH usage, in-person clinic visits, and inpatient and neurosurgical case volumes from March 2, 2020 to June 26, 2020 were obtained for retrospective analysis.ResultsTH use increased soon after the case suspension started and then decreased to little usage. The number of in-person visits were significantly lower during elective case suspension compared with when cases were resumed. Twenty-five percent of all visits during the suspension were conducted using TH. Thirty-nine percent of TH-visit patients were new patients, 11% were preoperative, 10% were postoperative, and 39% were other existing patients. Forty-eight percent of TH visits resulted in a later in-person clinic visit. After the suspension, in-person visits rebounded to 98% of the prepandemic numbers and TH visits were low.ConclusionsTH visits were challenging due to the need for in-person physical examinations in neurosurgery. TH temporarily accommodated patient needs during the pandemic but could not totally replace in-person visits and was not sustained after 3.5 months of use. Video TH visits worked well for nonurgent issues, such as minor visual examinations. Our findings could help guide the implementation of TH should similar circumstances arise again.

855-P: Health Care Delivery for Young Adults (YAs) with Type 1 Diabetes (T1D) during the Pandemic

Background: YAs, aged 18-30 years, with T1D have high risk of worsening glycemic control and loss to follow-up. In March 2020, the COVID-19 pandemic required a sudden change in healthcare delivery from in-person to telehealth visits. We aimed to evaluate use of telehealth by YAs with T1D during this time and assess characteristics associated with telehealth usage. Method: Frequency of telehealth visits from 3/16/2020 to 9/30/2020 was compared with in-person visits during the same calendar period before COVID-19 (3/16/2019 to 9/30/2020) in a sample of YAs with T1D seen by pediatric and adult diabetes clinicians. The Electronic Health Record provided demographic and clinical data for YAs aged 18-30 with a pre-pandemic A1c. Descriptive statistics and t-tests compared data before and during COVID-19. Results: Pre-COVID-19, there were 1177 YAs (50% male) with mean±SD age 24.4±3.4 years, T1D duration 12.8±5.9 years, and A1c 8.1±1.6%; 46% were pump-treated, 55% used CGM, and 91% had private insurance. In 2019, there were 2961 visits; in 2020, there were 2701 visits. For the two 6-month periods, the mean number of visits per YA declined significantly, from 2.5±2.5 in 2019 to 2.3±3.1 in 2020 (p=.02). Further, 20% (n=240) of YAs had no visits during the pandemic period. YAs with an A1c <7% pre-pandemic (21%, n=247) had fewer visits during the pandemic than before the pandemic (1.6±2.7 vs. 2.2±2.7, p=.001). YA males (p=.01), those using CGM (p=.02), and those on injection based therapy (p=.0002) had fewer visits during COVID-19. Conclusions: The majority of YAs (80%) maintained follow-up T1D care during the initial six months of telehealth implementation due to COVID-19, especially those with less favorable characteristics (e.g., A1c ≥7%, no CGM use). Maintaining telehealth options can become an effective means to improve future health outcomes for at-risk groups, such as YAs with T1D. Disclosure A. Shapira: None. L. J. Tinsley: None. E. Freiner: None. L. M. Laffel: Consultant; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Dexcom, Inc., Dompe, Insulogic LLC, Janssen Pharmaceuticals, Inc., Laxmi Therapeutic Devices, LifeScan, Lilly Diabetes, Medtronic, Provention Bio, Inc. E. Toschi: Consultant; Self; Medtronic. Funding Thomas J. Beatson, Jr. Foundation; National Institutes of Health (T32DK007260, P30DK036836)

Impact of COVID-19 Pandemic on Use of Telemedicine Services in an Academic Medical Center.

The COVID-19 pandemic changed the landscape of telehealth services. The goal of this paper was to identify demographic groups of patients who have used telemedicine services before and after the start of the pandemic, and to analyze how different demographic groups' telehealth usage patterns change throughout the course of the pandemic. A de-identified study dataset was generated by querying electronic health records at the Mount Sinai Health System to identify all patients. 129,625 patients were analyzed. Demographic shifts in patients seeking telemedicine service were identified. There was significant increase in the middle age and older population using telehealth services. During the pandemic use of telemedicine services was increased among male patients and racial minority patients. Furthermore, telehealth services had expanded to a broader spectrum of medical specialties.

Covid-19 Impacts on Florida’s Healthcare Professionals

This study described how COVID-19 impacted employment, telehealth usage, and interprofessional collaboration. A cross-sectional survey was deployed in June 2020 to healthcare professionals in Florida. Job status was uniquely separated by profession, with more nurses and medical doctors reported having no effect, and more mental health counselors transitioned to telehealth. Over a third of rehabilitation providers reported being furloughed. Over forty percent of providers had no training in telehealth, yet 33.1% reported an increase in usage. Interprofessional interactions are lower across professions during the pandemic, compared with before. This study shows the need for additional training on telehealth and interprofessional collaboration.

Patient experiences with telehealth in sleep medicine: a qualitative evaluation.

The field of sleep medicine has been an avid adopter of telehealth, particularly during the COVID-19 pandemic. The goal of this study was to assess patients' experiences receiving sleep care by telehealth. From June 2019 to May 2020, the authors recruited a sample of patients for semi-structured interviews, including patients who had 1 of 3 types of telehealth encounters in sleep medicine: in-clinic video, home-based video, and telephone. Two analysts coded transcripts using content analysis and identified themes that cut across patients and categories. The authors conducted interviews with 35 patients and identified 5 themes. (1) Improved access to care: Patients appreciated telehealth as providing access to sleep care in a timely and convenient manner. (2) Security and privacy: Patients described how home-based telehealth afforded them greater feelings of safety and security due to avoidance of anxiety-provoking triggers (eg, crowds). Patients also noted a potential loss of privacy with telehealth. (3) Personalization of care: Patients described experiences with telehealth care that either improved or hindered their ability to communicate their needs. (4) Patient empowerment: Patients described how telehealth empowered them to manage their sleep disorders. (5) Unmet needs: Patients recognized specific areas where telehealth did not meet their needs, including the need for tangible services (eg, mask fitting). Patients expressed both positive and negative experiences, highlighting areas where telehealth can be further adapted. As telehealth in sleep medicine continues to evolve, the authors encourage providers to consider these aspects of the patient experience. Donovan LM, Mog AC, Blanchard KN, et al. Patient experiences with telehealth in sleep medicine: a qualitative evaluation. J Clin Sleep Med. 2021;17(8):1645-1651.

The Long Shadow: Collateral Impact and Finding Resilience Amidst a Global Pandemic Pediatric Palliative Care Social Work During COVID-19

This manuscript illuminates the nuanced ways in which the COVID-19 pandemic has impacted the pediatric palliative care social work role and clinical care in caring for children with life-limiting illnesses and their families throughout the country. The authors discuss memorable moments, logistical impacts, telehealth usage, decision-making experiences, end of life care, bereavement practices, specialized interventions, and self-care. The paper concludes with lessons learned and practical recommendations for the future.

Adoption and Usage of Video Telehealth in a Large, Academic Department of Surgery.

To understand the impact that video telehealth has on outpatient visit volume and reimbursement as a method of maintaining care. As the coronavirus disease 2019 (COVID-19) spread across the United States starting in 2020, it caused numerous areas of medicine and healthcare to reexamine how we provide care to patients across all disciplines. One method clinicians used to rapidly adapt to these transformed settings was video telehealth, which was previously rarely used. This retrospective review examined outpatient volume and reimbursement data of a large, academic department of surgery. The study reviewed data during 2 time periods: pre-COVID-19 (February 1, 2020, to March 15, 2020) and COVID-19 (March 16, 2020, to April 30, 2020). During the period of February 1 to April 30, 13,193 outpatient visits were analyzed. The pre-COVID-19 group contained 9041 (68.5%) visits, whereas the COVID-19 group contained 4152 (31.4%) visits. All divisions noted a drop in visit volume from pre-COVID-19 compared with COVID-19. There was rapid adoption of video telehealth during COVID-19, which made up most patient visits during that time (61.3%). We also found that video telehealth led to significant reimbursements while also allowing patients in numerous states to receive care. Previously, video telehealth was used by clinicians in a small portion of outpatient visits. However, safety concerns surrounding COVID-19 forced multiple changes to the way care is provided. Although outpatient volume at our center was less than that before the pandemic, video telehealth was rapidly adopted by providers and allowed for safe and effective outpatient care to patients in a high number of states while still being reimbursed at a high rate.

Abstract SS2-08: Patient perception of telehealth services for breast and gynecologic cancer care during the SARS-CoV-2 (COVID-19) pandemic in NYC: A single center survey-based study

Abstract Background: Prior to the COVID-19 pandemic, telehealth was rarely utilized in providing oncologic care. At our large NYC based outpatient clinic, telehealth services were quickly adapted for utilization for visits that could be completed outside of the clinic, in order to limit patient exposure to the novel coronavirus. This survey-based study aimed to assess patient perceptions of the utility of telehealth in their oncologic care during a time of national crisis. Methods: A 34-question survey was administered to all patients receiving care at our outpatient center between March 1, 2020 and June 30, 2020 including those who had visits delayed or cancelled during this time period. Of the 622 patients who received the survey via RedCap online or physical copy in clinic, 211 (34%) completed the survey. For evaluation of the Telehealth provided during the pandemic, we have adapted the validated SUTAQ (Service User Technology Acceptability Questionnaire) which assesses patient acceptability of telehealth via measures of accessibility, comfort, usability, privacy and security, confidentiality, satisfaction, convenience and health benefits with in-home telemonitoring. Results: All patients who completed the survey had a history of DCIS/ADH/LCIS, invasive breast cancer or gynecologic malignancy. Of the total survey respondents, 72 (35%) participated in a telehealth visit during the four month evaluation period. For all survey questions, “agreement” was considered if the patient selected mildly, moderately or strongly agreed on the SUTAQ scale. Of patients who participated in telehealth visits, 66 (92%) felt that the telehealth saved them time, 52 (72%) felt it increased their access to care and 56 (81%) felt it helped improve their health. Only 8 (12%) of patients felt that telehealth made them feel uncomfortable and 4 (6%) worried about confidentiality related to telehealth usage. Overall, 65 (92%) of patients were satisfied with the telehealth services they received and 64 (89%) would recommend these services to people with similar health conditions. Twenty-five (35%) felt that telehealth can be a replacement for their normal health care and 67 (93%) reported it could be a good addition to their care. Fifty-four (76%) would be interested in participating in telehealth visits in the future. Conclusions: Overall, patients expressed satisfaction with the use of telehealth services for oncologic care during the COVID pandemic. Although most patients do not feel that this is a suitable replacement for their in person care, they expressed that it was certainly a good addition to their care. A large majority of patients expressed interest in continuing to participate in telehealth visits in the future. Telehealth services should be carefully adapted as a long term addition to the in person clinical care of patients with cancer. These services should be utilized to optimize patient satisfaction, save time and increase access to care, especially among high risk patients. Citation Format: Brittney S Zimmerman, Danielle Seidman, Natalie Berger, Krystal P Cascetta, Michelle Nezolosky, Kara Trlica, Alisa Ryncarz, Caitlin Keeton, Erin Moshier, Amy Tiersten. Patient perception of telehealth services for breast and gynecologic cancer care during the SARS-CoV-2 (COVID-19) pandemic in NYC: A single center survey-based study [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr SS2-08.

Optimizing the Use of Telemedicine in Oncology Care: Postpandemic Opportunities.

Utilization of telehealth as part of the cancer care delivery continuum dramatically escalated in response to the COVID-19 pandemic at major cancer centers across the globe. The rapid shift toward telehealth visits for nontreatment cancer care provided immediate benefit through reducing unnecessary risk of exposure, overcoming transportation barriers faced by both patients and caregivers, and fast-tracking care transformation. As such, delineating the impact of telehealth on access, health equity, quality, and outcomes will be essential for refining the use of digital strategies and telehealth toward optimizing cancer care. Herein, experiences to date with telehealth usage for oncology care are reviewed, and priorities are outlined for postpandemic opportunities to improve the lives of patients with cancer through telemedicine.

Physician Perspective and Key Satisfaction Indicators with Rapid Telehealth Adoption During the Coronavirus Disease 2019 Pandemic.

Background: Physician satisfaction with telehealth during the coronavirus disease 2019 pandemic is a strong indicator for future use. Validated surveys can guide improvement and future expansion of telehealth programs. Introduction: This study examines physician and advanced practice provider perspectives and satisfaction using telehealth at UPMC Pinnacle and to assess key predictors of future use in ambulatory care. Methods: A web-based Likert scale survey of UPMC Pinnacle physicians and advanced practice providers was conducted in May-June 2020. Cronbach's alpha was used to measure the survey's internal consistency. Crosstab analysis and multivariate regression were used to analyze the interrelationships between variables. Results: A significant majority (64%) of physicians responded positively that they enjoyed telehealth video visits. A majority (65%) felt that the physician-patient relationship was unimpaired during telehealth visits, but only 29% of the respondents felt they were able to examine the patients properly. Providers who experienced good video and audio quality were 3.68 times more likely to enjoy telehealth visits (p < 0.001, 95% confidence interval 2.05-6.61) than those with less-than-optimal video and audio quality. Logistic regression shows a strong correlation between the audio and image quality and respondents' satisfaction with telehealth. Discussion: The key barriers for patients when using telehealth are perceived to be the ability to use a smartphone app, password management, or video/microphone features. For clinicians, barriers include problems with seeing and hearing on the platform. Conclusions: Patient education and improvement of audio and image quality are essential for improving telehealth usage and satisfaction.

COVID-19 and the rise of virtual medicine in spine surgery: a worldwide study

PurposeThe COVID-19 pandemic forced many surgeons to adopt “virtual medicine” practices, defined as telehealth services for patient care and online platforms for continuing medical education. The purpose of this study was to assess spine surgeon reliance on virtual medicine during the pandemic and to discuss the future of virtual medicine in spine surgery.MethodsA comprehensive survey addressing demographic data and virtual medicine practices was distributed to spine surgeons worldwide between March 27, 2020, and April 4, 2020.Results902 spine surgeons representing seven global regions responded. 35.6% of surgeons were identified as “high telehealth users,” conducting more than half of clinic visits virtually. Predictors of high telehealth utilization included working in an academic practice (OR = 1.68, p = 0.0015) and practicing in Europe/North America (OR 3.42, p < 0.0001). 80.1% of all surgeons were interested in online education. Dedicating more than 25% of one’s practice to teaching (OR = 1.89, p = 0.037) predicted increased interest in online education. 26.2% of respondents were identified as “virtual medicine surgeons,” defined as surgeons with both high telehealth usage and increased interest in online education. Living in Europe/North America and practicing in an academic practice increased odds of being a virtual medicine surgeon by 2.28 (p = 0.002) and 1.15 (p = 0.0082), respectively. 93.8% of surgeons reported interest in a centralized platform facilitating surgeon-to-surgeon communication.ConclusionCOVID-19 has changed spine surgery by triggering rapid adoption of virtual medicine practices. The demonstrated global interest in virtual medicine suggests that it may become part of the “new normal” for surgeons in the post-pandemic era.

1042. The Attitude of Patients With HIV about Telehealth for Their HIV Care

BackgroundThe world is facing a pandemic of SARS-CoV-2 that disrupted our healthcare system and the way we deliver healthcare. For people with HIV (PWH), the ability to be retained in care plays a critical role in improving health outcomes and in preventing HIV transmission. Several definitions exist for retention in care, but they are centered around outpatient clinic visits. It is now more important than ever to understand PWH’s attitudes about using telemedicine for HIV care instead of face-to face clinic visits.MethodsWe administered a one-time survey to PWH presenting to an outpatient HIV center in Houston, Texas, from February–June 2018. The survey items were used to assess PWH’s attitudes towards and concerns for telehealth and explanatory variables.Results371 participants completed the survey; median age was 51, 36% were female, and 63% African-American. Overall, 57% of respondents were more likely to use telehealth for their HIV care if available, as compared to one-on-one in-person care, and 37% would use telehealth frequently or always as an alternative to clinic visits.Participants reported many benefits including ability to fit better their schedule, decreasing travel time, and privacy but expressed concerns about the ability to effective communication and examination and the safety of personal information. Factors associated with likelihood of using telehealth include personal factors (US-born, men who have sex with men, higher educational attainment, higher HIV-related stigma perception), HIV-related factors (long standing HIV), and structural factors (having difficulty attending clinic visits, not knowing about or not having the necessary technology). There was no association between participants with uncontrolled HIV, medication adherence, and likelihood of using telehealth.Survey items and response distribution ConclusionTelehealth programs for PWH can improve retention in care. A modification of the definition for retention in care, incorporating telehealth, should be considered. Availability and confidence using various telehealth technologies need to be addressed to increase acceptability and usage of telehealth among PWH.Disclosures All Authors: No reported disclosures

Educational intervention to increase nurses’ knowledge, self-efficacy and usage of telehealth: A multi-setting pretest-posttest study

The widespread use of telehealth, providing healthcare remotely, is hampered by various barriers. Dutch nurses currently working in practice never received education in this new way of healthcare delivery. Education is frequently suggested as a strategy to overcome barriers in telehealth use. However, the nature and effectiveness of such education has not yet been specified and tested in practice. In a previous study, we identified 14 nursing telehealth activities and accompanying competencies. In the current study, we established the effectiveness of training in these competencies on nurses' subjective knowledge, self-efficacy and usage of telehealth. A two-day tailored training program in nursing telehealth activities was evaluated in a Dutch context among 37 participants across three settings: (a) twelve primary care (PC), (b) fourteen homecare (HC) and (c) eleven hospital (H) nurses. In each team, telehealth knowledge significantly increased during the training sessions. In each team, nurses' telehealth self-efficacy also significantly increased 6–10 weeks after the training. After the training, the number of remote consultations increased from 2 to 12 in primary care, 12 to 35 in homecare and decreased from 28 to 17 in the hospital setting. We conclude that training nurses in telehealth activities contributes to their knowledge and self-efficacy.

Surgery Provider Perceptions on Telehealth Visits During the COVID-19 Pandemic: Room for Improvement

BackgroundCOVID-19 has mandated rapid adoption of telehealth for surgical care. However, many surgical providers may be unfamiliar with telehealth. This study evaluates the perspectives of surgical providers practicing telehealth care during COVID-19 to help identify targets for surgical telehealth optimization. Materials and methodsAt a single tertiary care center with telehealth capabilities, all department of surgery providers (attending surgeons, residents, fellows, and advanced practice providers) were emailed a voluntary survey focused on telehealth during the pandemic. Descriptive statistics and Mann–Whitney U analyses were performed as appropriate on responses. Text responses were thematically coded to identify key concepts. ResultsThe completion rate was 41.3% (145/351). Providers reported increased telehealth usage relative to the pandemic (P < 0.001). Of respondents, 80% (116/145) had no formal telehealth training. Providers estimated that new patient video visits required less time than traditional visits (P = 0.001). Satisfaction was high for several aspects of video visits. Comparatively lower satisfaction scores were reported for the ability to perform physical exams (sensitive and nonsensitive) and to break bad news. The largest barriers to effective video visits were limited physical exams (55.6%; 45/81) and lack of provider or patient internet access/equipment/connection (34.6%; 28/81). Other barriers included ineffective communication and difficulty with fostering rapport. Concerns regarding video-to-telephone visit conversion were loss of physical exam/visual cues (34.3%; 24/70), less personal interactions (18.6%; 13/70), and reduced efficiency (18.6%; 13/70). ConclusionsTelehealth remains a new experience for surgical providers despite its expansion. Optimization strategies should target technology barriers and include specialized virtual exam and communication training.

Understanding the impact of teledermatology on no-show rates and health care accessibility: A retrospective chart review

At the onset of the COVID-19 pandemic, emergency legislation expanding the coverage of telehealth service swept across the nation to allow for continued access to medical care despite strict shelter-in-place guidelines.1 In the wake of this, telehealth usage has increased dramatically.2 Dermatology, in particular, is uniquely amenable to virtual visits, and teledermatology has the potential to become a permanent platform from which we provide specialty care.

A Telehealth Explosion: Using Lessons from the Pandemic to Shape the Future of Telehealth Regulation

The coronavirus pandemic has changed the way individuals work and live, with an ever increasing reliance on technology to carry out daily life. Like schools and business, physicians and physician offices around the country not tasked with treating patients suffering from COVID-19 shuttered their doors and turned to technology, through telehealth, to render necessary healthcare services. Telehealth services, generally defined as being able to diagnose and/or treat a patient via technology as opposed to in-person, have been around for some time, but there have been significant barriers that have hindered widespread growth. Despite this, telehealth advocates have been doggedly and slowly pushing for expansion and trying to break through the known obstacles for decades in an effort to hopefully achieve the touted gains from telehealth, such as enhanced health care services to rural and medically underserved populations, more integrated care across platforms to coordinated providers all treating the same episode of care, and greater convenience and efficiency for the patients and providers for some of the more basics health care needs. Now, the global pandemic has pushed telehealth services into the mainstream and, like a set of dominoes, various federal and state restrictions and limitations that have been built up over the years around telehealth were suddenly waived in order to allow patients to continue to seek necessary medical care. Unlike before, however, patients now found themselves able to access such services from their homes or other places of residence. While some of the restrictions previously in place are likely to return, many are speculating that the pandemic has finally been telehealth’s “tipping point” and could usher in more robust and widespread use of telehealth even after the pandemic has passed or at least waned. As telehealth services have become more widely available and proven to be useful, it now seems unlikely there will be a return to the previous status quo for the industry, but this still leaves the industry, regulators, and enforcers to contemplate what the telehealth industry should look like in a post-pandemic environment. This is a unique time to be able to observe the use of telehealth in an unfettered state and, through that lens, provide legislators and policymakers with valuable data to reconsider the delivery of telehealth and its regulatory structure with the goal of enacting practical and workable regulations that advance efficient and effective health care delivery. To this end, Part I of this Article will examine the history of telehealth, from its early origins, and define what telehealth means today in all of its various forms. Part I will further explain the restrictions and regulatory structure, both federal and state, that applied to telehealth prior to the coronavirus pandemic and the then-current enforcement trends. Next, Part II will describe all of the various waivers and regulatory changes that went into effect in response to the coronavirus pandemic and examine how the pandemic has fueled increased telehealth growth. Part II will also analyze trends realized during the pandemic and other usage data to consider the impact and effect of the waivers and loosening of restrictions on telehealth services. This Article will then argue in Part III that legislators and regulators should avoid either a return to status quo or a permanent adoption of all of the waivers in effect and should instead utilize data and evidence gathered during this time period when restrictions were largely lifted to understand the true concerns raised by telehealth usage and consider a revised regime that focuses its attention and efforts on those aspects of the regulatory structure that are most detrimental to the health and safety of patients and consumers. It will further provide some general recommendations for reconsidering the telehealth regulatory regime once the public health emergency has subsided in order to promote the use of telehealth in a way that enhances and enriches the benefits of telehealth, without harming patients and consumers. Finally, Part IV will conclude with some final thoughts regarding the importance of reimaging the telehealth infrastructure for a sustained and successful future.

CORR Insights®: What Was the Change in Telehealth Usage and Proportion of No-show Visits for an Orthopaedic Trauma Clinic During the COVID-19 Pandemic?

CORR Insights®: What Was the Change in Telehealth Usage and Proportion of No-show Visits for an Orthopaedic Trauma Clinic During the COVID-19 Pandemic?

Tracking the Volume of Neurosurgical Care During the Coronavirus Disease 2019 Pandemic

ObjectiveIn the present study, we quantified the effect of the coronavirus disease 2019 (COVID-19) on the volume of adult and pediatric neurosurgical procedures, inpatient consultations, and clinic visits at an academic medical center.MethodsNeurosurgical procedures, inpatient consultations, and outpatient appointments at Vanderbilt University Medical Center were identified from March 23, 2020 through May 8, 2020 (during COVID-19) and March 25, 2019 through May 10, 2019 (before COVID-19). The neurosurgical volume was compared between the 2 periods.ResultsA 40% reduction in weekly procedural volume was demonstrated during COVID-19 (median before, 75; interquartile range [IQR], 72–80; median during, 45; IQR, 43–47; P < 0.001). A 42% reduction occurred in weekly adult procedures (median before, 62; IQR, 54–70; median during, 36; IQR, 34–39; P < 0.001), and a 31% reduction occurred in weekly pediatric procedures (median before, 13; IQR, 12–14; median during, 9; IQR, 8–10; P = 0.004). Among adult procedures, the most significant decreases were seen for spine (P < 0.001) and endovascular (P < 0.001) procedures and cranioplasty (P < 0.001). A significant change was not found in the adult open vascular (P = 0.291), functional (P = 0.263), cranial tumor (P = 0.143), or hydrocephalus (P = 0.173) procedural volume. Weekly inpatient consultations to neurosurgery decreased by 24% (median before, 99; IQR, 94–114; median during, 75; IQR, 68–84; P = 0.008) for adults. Weekly in-person adult and pediatric outpatient clinic visits witnessed a 91% decrease (median before, 329; IQR, 326–374; median during, 29; IQR, 26–39; P < 0.001). In contrast, weekly telehealth encounters increased from a median of 0 (IQR, 0–0) before to a median of 151 (IQR, 126–156) during COVID-19 (P < 0.001).ConclusionsSignificant reductions occurred in neurosurgical operations, clinic visits, and inpatient consultations during COVID-19. Telehealth was increasingly used for assessments. The long-term effects of the reduced neurosurgical volume and increased telehealth usage on patient outcomes should be explored.

Exploring the Attitude of Patients with HIV About Using Telehealth for HIV Care.

Telehealth could address many of the factors identified as barriers for retention in HIV care. In this study, we explore people with HIV (PWH)'s attitudes about using telemedicine for HIV care instead of face-to-face clinic visits. We administered a one-time survey to PWH presenting to an outpatient HIV center in Houston, Texas, from February to June 2018. The survey items were used to assess PWH's attitudes toward and concerns for telehealth and explanatory variables; 371 participants completed the survey; median age was 51, 36% and were female, and 63% was African American. Overall 57% of respondents were more likely to use telehealth for their HIV care if available, as compared with one-on-one in-person care, and 37% would use telehealth frequently or always as an alternative to clinic visits. Participants reported many benefits, including ability to fit better their schedule, decreasing travel time, and privacy but expressed concerns about the ability to effective communication and examination and the safety of personal information. Factors associated with likelihood of using telehealth include personal factors (US-born, men who have sex with men, higher educational attainment, higher HIV-related stigma perception), HIV-related factors (long-standing HIV), and structural factors (having difficulty attending clinic visits, not knowing about or not having the necessary technology). There was no association between participants with uncontrolled HIV, medication adherence, and likelihood of using telehealth. Telehealth programs for PWH can improve retention in care. Availability and confidence using various telehealth technologies need to be addressed to increase acceptability and usage of telehealth among PWH.

Telehealth: An Opportunity for State and Territorial Health Agencies to Improve Access to Needed Health Services.

Telehealth: An Opportunity for State and Territorial Health Agencies to Improve Access to Needed Health Services.