Telemedicine Encounters Research Articles

The environmental impact of surgical telemedicine: life cycle assessment of virtual vs. in-person preoperative evaluations for benign foregut disease.

Health care accounts for almost 10% of the United States' greenhouse gas emissions, accounting for a loss of 470,000 disability-adjusted life years based on the health effects of climate change. Telemedicine has the potential to decrease health care's carbon footprint by reducing patient travel and clinic-related emissions. At our institution, telemedicine visits for evaluation of benign foregut disease were implemented for patient care during the COVID-19 pandemic. We aimed to estimate the environmental impact of telemedicine usage for these clinic encounters. We used life cycle assessment (LCA) to compare greenhouse gas (GHG) emissions for an in-person and a telemedicine visit. For in-person visits, travel distances to clinic were retrospectively assessed from 2020 visits as a representative sample, and prospective data were gathered on materials and processes related to in-person clinic visits. Prospective data on the length of telemedicine encounters were collected and environmental impact was calculated for equipment and internet usage. Upper and lower bounds scenarios for emissions were generated for each type of visit. For in-person visits, 145 patient travel distances were recorded with a median [IQR] distance travel distance of 29.5 [13.7, 85.1] miles resulting in 38.22-39.61 carbon dioxide equivalents (kgCO2-eq) emitted. For telemedicine visits, the mean (SD) visit time was 40.6 (17.1) min. Telemedicine GHG emissions ranged from 2.26 to 2.99 kgCO2-eq depending on the device used. An in-person visit resulted in 25 times more GHG emissions compared to a telemedicine visit (p < 0.001). Telemedicine has the potential to decrease health care's carbon footprint. Policy changes to facilitate telemedicine use are needed, as well as increased awareness of potential disparities of and barriers to telemedicine use. Moving toward telemedicine preoperative evaluations in appropriate surgical populations is a purposeful step toward actively addressing our role in health care's large carbon footprint.

Chronic pain management during the COVID-19 pandemic: Can telemedicine replace in-person consultation? A prospective clinical study

IntroductionThe COVID-19 pandemic forced numerous pain clinics to suspend their services. For chronic pain patients, even a temporary closure and inability to connect with their healthcare providers may result in adverse outcomes. There are serious concerns regarding worsening of physical and emotional suffering and a surge in substance abuse. Therefore, telemedicine, also called telehealth, would seem to be a reasonable alternative to in-person clinic visits during the lockdowns. However, it remains unclear whether a telemedicine consultation is adequate for diagnostic purposes and subsequent intervention planning. MethodsThis study was conducted as an open-label cohort study on new patients referred to an interdisciplinary community pain clinic focused on image-guided interventions. The primary outcome was to determine whether a video consultation was sufficient to make an initial diagnosis and plan subsequent interventions. Secondary variables included technical feasibility, patient satisfaction, calculated nonincurred cost and time-saving. Video consultations were performed using a secure videoconference system consistent with routine clinic practice. ResultsSixty-five participants were recruited, and 49 (75.4%) completed the study. Patients for whom interventional approaches were not recommended elected not to continue with clinic visits. The intra-observer agreement rate between the telemedicine and in-person encounter was 93.9% (95% CI 87.2-100) for the diagnostic codes and treatment plan. The median satisfaction score from the telemedicine encounter was seven on a scale of 0–7, and it remained 6 when the remote care experience was later compared with the in-person visit. There were considerable savings in travel time and expenses. DiscussionThe study experimentally validated the ability of telemedicine encounters to establish a diagnosis and formulate an interventional pain management plan of care. The validity of virtual consultation for complex pain care remains to be determined. It is unreasonable to expect telemedicine to completely replace clinic visits in the foreseeable future. However, judicious use of technology may facilitate timely scheduling, save time and resources, and improve satisfaction without jeopardizing the quality of care.

DEA, SAMHSA Release Temporary Rule Extending Telemedicine Flexibilities

Back to table of contents Previous article Next article ProfessionalFull AccessDEA, SAMHSA Release Temporary Rule Extending Telemedicine FlexibilitiesTerri D'ArrigoTerri D'ArrigoSearch for more papers by this authorPublished Online:11 May 2023https://doi.org/10.1176/appi.pn.2023.06.6.2AbstractThe rule extends the full set of telemedicine flexibilities adopted during the COVID-19 PHE through November 11. Additional flexibilities will extend to established patients until November 11, 2024.The U.S. Drug Enforcement Administration (DEA) and Substance Abuse and Mental Health Services Administration (SAMHSA) issued a temporary rule on May 10 that extends telemedicine flexibilities adopted during the COVID-19 Public Health Emergency (PHE). The temporary rule is effective today, May 11, and extends the full set of telemedicine flexibilities adopted during the COVID-19 PHE for six months (through November 11). Additional flexibilities will extend to established patients until November 11, 2024.“Access to evidence-based treatment is a pillar of the HHS Overdose Prevention Strategy,” said Miriam E. Delphin-Rittmon, Ph.D., the Health and Human Services (HHS) assistant secretary for mental health and substance use and the leader of SAMHSA, in a press release issued by SAMHSA. “We strongly support policies that promote access to effective and safe treatment for opioid use disorder, including through telemedicine platforms, and ensuring continued access to necessary controlled medications past the COVID-PHE.”This development is the latest in a story that began back in February, when the DEA announced two proposed rules (Docket No. DEA–407 and Docket No. DEA–948) for the prescribing of controlled medications via telemedicine. There was a 30-day public comment period for the proposed rules, which ended on March 31.The nation cannot afford policies that make it more difficult for patients to get the medications they need, says APA CEO and Medical Director Saul Levin, M.D., M.P.A.APA filed two letters with the DEA in response to the proposed rules during this time, recommending that the DEA “focus on balancing common-sense safeguards for DEA enforcement without decreasing access to lifesaving treatment” and consider ways to extend flexibilities made during the COVID-19 PHE. These comments were just two of the tens of thousands of comments that the agency received.DEA Administrator Anne Milgram on May 3 announced that the agency had received “a record 38,000 comments on its proposed telemedicine rules” and would delay releasing the two permanent rules that were set to go into effect when the COVID-19 PHE ends. “We take those [38,000] comments seriously and are considering them carefully,” Milgram said.The SAMHSA release noted: “For any practitioner-patient telemedicine relationships that have been or will be established up to November 11, 2023, the full set of telemedicine flexibilities regarding prescription of controlled medications established during the COVID-19 PHE will be extended for one year—through November 11, 2024.”“We recognize the importance of telemedicine in providing Americans with access to needed medications, and we have decided to extend the current flexibilities while we work to find a way forward to give Americans that access with appropriate safeguards,” Milgram said.“We are pleased that the DEA is taking the time to consider carefully the impact the proposed rules would have on patients, many of whom rely on telehealth as a means of accessing care,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A. “At a time when the nation faces both a mental health crisis and an opioid crisis, we cannot afford policies that make it harder for patients to get the medications they need.” ■ResourcesThe temporary DEA rule “Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications”Proposed DEA rule “Telemedicine Prescribing of Controlled Substances When the Practitioner and the Patient Have Not Had a Prior In-Person Medical Evaluation”Proposed DEA rule “Expansion of Induction of Buprenorphine via Telemedicine Encounter”Statement from the DEA Administrator Anne Milgram on COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications ISSUES NewArchived

Utilizing Simulated Telemedicine Encounters to Study Communication Practices of Oncologists with Simulated Patients (Sch474)

Utilizing Simulated Telemedicine Encounters to Study Communication Practices of Oncologists with Simulated Patients (Sch474)

Use of Simulation to Develop Telestroke Skills in Trainees (S10.009)

<h3>Objective:</h3> To create an educational intervention to prepare neurology residents for telestroke encounters. <h3>Background:</h3> Telemedicine has become increasingly common in the post-COVID era and is now a part of most clinical practices. There is a need for residency training programs to incorporate telemedicine teaching into their curriculum. Telestroke is a well-established practice and way to bring neurovascular clinical expertise into settings where an in-person stroke specialist may not be available. Skills and professionalism important in a remote telestroke consult apply to all types of telemedicine encounters. <h3>Design/Methods:</h3> Our telestroke OSCE (objective structured clinical examination) case was developed by our neurology faculty in conjunction with a simulation specialist. Two standardized actors were trained to impersonate an acute stroke patient and a bedside provider in an emergency room setting. The neurology resident learner was in a separate room and acted as a stroke specialist, communicating with the standardized actors and conducting an NIHSS using a live video interface. Following the encounter, immediate feedback was given by a faculty observer and the standardized actor rated resident performance using a checklist. After OSCEs were completed, the residents were debriefed in a group setting and a learner feedback survey was collected (1–5, least-most). <h3>Results:</h3> Out of 15 resident participants, 8 completed the learner survey (53%). They reported feeling fairly well-prepared for the OSCE (4±0.5) and rated their performance overall well (4.3±0.5). Many learners identified instructing the standardized remote provider in the NIHSS virtually as the most challenging aspect in the encounter. All learners indicated that this OSCE should be repeated for future residency classes. <h3>Conclusions:</h3> We demonstrated that a telestroke simulation is a useful tool to directly observe residents, offer immediate feedback and review telemedicine best-practices. It is a feasible, valued and important part of our dynamic neurology residency curriculum. <b>Disclosure:</b> Dr. Lillemoe has nothing to disclose. Dr. Kurzweil has nothing to disclose. Dr. Sabadia has nothing to disclose. Dr. Pleninger has nothing to disclose. Dr. Lewis has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Seminars in Neurology. Dr. Lewis has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Journal of Clinical Neuroscience. Dr. Giglio has nothing to disclose. Sondra Zabar has nothing to disclose.

A review of questionnaires used for the assessment of telemedicine

Introduction Telemedicine is the exchange of medical information from one site to another via electronic communications with the goal of improving a patient's clinical health status. Prior studies have identified the absence of a standardized assessment tool for evaluating telemedicine encounters. This study aims to collect and to analyze questionnaires used for the assessment of audiovisual telemedicine encounters from a patient perspective and aims to identify reasons driving the use of self-developed questionnaires. Methods We conducted a systematic search in PubMed for studies that used survey questionnaires to assess synchronous audiovisual telemedicine encounters from 2016 to 2021. We categorized questionnaires used into validated and non-validated types, and for each of them, collected questions, response format, author, year, specialty, and country of publication. Results and Discussion We analyzed a total of 71 articles. We found that only 16 studies used three validated questionnaires. The remaining 55 studies used non-validated questionnaires. Non-validated questionnaires had a high variability in length and used Likert scales, binary responses, multiple choice, and open-ended answers. We found only eight studies in which the authors gave a reason for resorting to designing their own questionnaires. This review reveals insufficient standardized survey questionnaires to be used for the assessment of audiovisual telemedicine encounters. Future research initiatives should focus on developing a standardized and validated instrument well accepted by researchers.

Seventy-Two-Hour Reutilization After Telemedicine Visits in Academic Pediatric Primary Care.

Telemedicine has expanded due to the COVID-19 pandemic. However, the health care usage after telemedicine visits compared with similar in-person visits is not known. This study compared the 72-hour health care reutilization after telemedicine visits and in-person acute encounters in a pediatric primary care office. A retrospective cohort analysis was performed in a single quaternary pediatric health care system between March 1, 2020, and November 30, 2020. Reutilization information was collected for 72 hours following the index visit and included subsequent encounters within the health care system. The 72-hour reutilization rate for telemedicine encounters was 4.1% compared with 3.9% for in-person acute visits. Of revisits, patients who had a telemedicine visit most often sought additional care at the medical home, and patients with an in-person visit most often sought additional care to the emergency department or urgent care. Telemedicine does not result in higher total health care reutilization.

Characteristics of telemedicine workflows in nursing homes during the COVID-19 pandemic

BackgroundThe use of telemedicine increased dramatically in nursing homes (NHs) during the COVID-19 pandemic. However, little is known about the actual process of conducting a telemedicine encounter in NHs. The objective of this study was to identify and document the work processes associated with different types of telemedicine encounters conducted in NHs during the COVID-19 pandemic.MethodsA mixed methods convergent study was utilized. The study was conducted in a convenience sample of two NHs that had newly adopted telemedicine during the COVID-19 pandemic. Participants included NH staff and providers involved in telemedicine encounters conducted in the study NHs. The study involved semi-structured interviews and direct observation of telemedicine encounters and post-encounter interviews with staff and providers involved in telemedicine encounters observed by research staff. The semi-structured interviews were structured using the Systems Engineering Initiative for Patient Safety (SEIPS) model to collect information about telemedicine workflows. A structured checklist was utilized to document steps performed during direct observations of telemedicine encounters. Information from interviews and observations informed the creation of a process map of the NH telemedicine encounter.ResultsA total of 17 individuals participated in semi-structured interviews. Fifteen unique telemedicine encounters were observed. A total of 18 post-encounter interviews with 7 unique providers (15 interviews in total) and three NH staff were performed. A 9-step process map of the telemedicine encounter, along with two microprocess maps related to encounter preparation and activities within the telemedicine encounter, were created. Six main processes were identified: encounter planning, family or healthcare authority notification, pre-encounter preparation, pre-encounter huddle, conducting the encounter, and post-encounter follow-up.ConclusionThe COVID-19 pandemic changed the delivery of care in NHs and increased reliance on telemedicine services in these facilities. Workflow mapping using the SEIPS model revealed that the NH telemedicine encounter is a complex multi-step process and identified weaknesses related to scheduling, electronic health record interoperability, pre-encounter planning, and post-encounter information exchange, which represent opportunities to improve and enhance the telemedicine encounter process in NHs. Given public acceptance of telemedicine as a care delivery model, expanding the use of telemedicine beyond the COVID-19 pandemic, especially for certain NH telemedicine encounters, could improve quality of care.

Provider Perspectives Regarding Ambulatory Telemedicine at a Large Academic Health System During the COVID-19 Pandemic.

Purpose: To understand provider preferences regarding telemedicine across clinical departments and provider demographic groups. Methods: A cross-sectional online survey was distributed to providers at Johns Hopkins Medicine who had completed at least one outpatient telemedicine encounter. The survey included questions about clinical appropriateness and preferred use of telemedicine. Demographic data were obtained from institutional records. Descriptive statistics provided a profile of provider responses. Wilcoxon rank sum tests evaluated departmental and demographic differences. Results: A total of 1,342 of 3,576 providers responded (37.5%). Providers indicated that telemedicine was clinically appropriate for new patients a median of 31.5% of the time (Range: 20% in pediatrics, 80% in psychiatry/behavioral sciences). For existing patients, providers indicated that telemedicine was clinically appropriate a median of 70% of the time (Range: 50% in physical medicine, 90% in psychiatry/behavioral sciences). Providers desired a median of 30% of their schedule template be dedicated to telemedicine (Range: 20% in family medicine, 70% in psychiatry/behavioral sciences). Providers who were female, had fewer than 15 years in practice, or were psychiatrists/psychologists tended to find telemedicine more clinically appropriate (p < 0.05). Conclusions: A majority of providers across clinical departments felt that high-quality care could be delivered through telemedicine, although the amount of care varied widely based on department and patient type. Preferences for future telemedicine similarly showed wide variety across and within departments. These findings indicate that in this early adoption phase of widespread telemedicine integration, there is lack of consensus among providers about the amount of telemedicine appropriate for everyday practice.

Development of a machine learning algorithm to identify surgical candidates for hip and knee arthroplasty without in-person evaluation.

Arthroplasty care delivery is facing a growing supply-demand mismatch. To meet future demand for joint arthroplasty, systems will need to identify potential surgical candidates prior to evaluation by orthopaedic surgeons. Retrospective review was conducted at two academic medical centers and three community hospitals from March 1 to July 31, 2020 to identify new patient telemedicine encounters (without prior in-person evaluation) for consideration of hip or knee arthroplasty. The primary outcome was surgical indication for joint replacement. Five machine learning algorithms were developed to predict likelihood of surgical indication and assessed by discrimination, calibration, overall performance, and decision curve analysis. Overall, 158 patients underwent new patient telemedicine evaluation for consideration of THA, TKA, or UKA and 65.2% (n = 103) were indicated for operative intervention prior to in-person evaluation. The median age was 65 (interquartile range 59-70) and 60.8% were women. Variables found to be associated with operative intervention were radiographic degree of arthritis, prior trial of intra-articular injection, trial of physical therapy, opioid use, and tobacco use. In the independent testing set (n = 46) not used for algorithm development, the stochastic gradient boosting algorithm achieved the best performance with AUC 0.83, calibration intercept 0.13, calibration slope 1.03, Brier score 0.15 relative to a null model Brier score of 0.23, and higher net benefit than the default alternatives on decision curve analysis. We developed a machine learning algorithm to identify potential surgical candidates for joint arthroplasty in the setting of osteoarthritis without an in-person evaluation or physical examination. If externally validated, this algorithm could be deployed by various stakeholders, including patients, providers, and health systems, to direct appropriate next steps in patients with osteoarthritis and improve efficiency in identifying surgical candidates. III.

Telehealth Providers: Begin Planning Now for End of COVID-19 PHE

Telehealth Providers: Begin Planning Now for End of COVID-19 PHE

A quality-improvement approach to urgent-care antibiotic stewardship for respiratory tract infections during the COVID-19 pandemic: Lessons learned.

We investigated a decrease in antibiotic prescribing for respiratory illnesses in 2 academic urgent-care clinics during the coronavirus disease 2019 (COVID-19) pandemic using semistructured clinician interviews. We conducted a quality-improvement project from November 2020 to May 2021. We investigated provider antibiotic decision making using a mixed-methods explanatory design including interviews. We analyzed transcripts using a thematic framework approach to identify emergent themes. Our performance measure was antibiotic prescribing rate (APR) for encounters with respiratory diagnosis billing codes. We extracted billing and prescribing data from the electronic medical record and assessed differences using run charts, p charts and generalized linear regression. We observed significant reductions in the APR early during the COVID-19 pandemic (relative risk [RR], 0.20; 95% confidence interval [CI], 0.17-0.25), which was maintained over the study period (P < .001). The average APRs were 14% before the COVID-19 pandemic, 4% during the QI project, and 7% after the project. All providers prescribed less antibiotics for respiratory encounters during COVID-19, but only 25% felt their practice had changed. Themes from provider interviews included changing patient expectations and provider approach to respiratory encounters during COVID-19, the impact of increased telemedicine encounters, and the changing epidemiology of non-COVID-19 respiratory infections. Our findings suggest that the decrease in APR was likely multifactorial. The average APR decreased significantly during the pandemic. Although the APR was slightly higher after the QI project, it did not reach prepandemic levels. Future studies should explore how these factors, including changing patient expectations, can be leveraged to improve urgent-care antibiotic stewardship.

Telemedicine Utilization Among Transgender and Gender-Diverse Adolescents Before and After the COVID-19 Pandemic.

Introduction: Little is known about how expansion of telemedicine services during the COVID-19 pandemic has affected access to gender-affirming care for transgender and gender-diverse (TGD) youth. The purpose of this study was to explore differences in demographic characteristics and visit completion rates at a multidisciplinary gender clinic before and after telemedicine implementation in March 2020 and among telemedicine users and nonusers. Methods: Data were from electronic health records of Seattle Children's Gender Clinic (SCGC) patients seen between April 2019 and February 2021. We assessed differences in demographic characteristics and care utilization (i.e., encounter type and status) between April 2019 and February 2020 (pre-telemedicine) and April 2020 and February 2021 (post-telemedicine). Results: Of the 1,051 unique patients seen at SCGC during this time period, majority groups were as follows: 62% identified as transmasculine/male, 68% were non-Hispanic White, and 76% resided within 50 miles of the clinic. Statistically significant differences were observed in patient pronouns and insurance type when comparing the pre- and post-telemedicine periods (p < 0.01). Half (52%) of post-telemedicine period encounters were conducted through telemedicine, and telemedicine encounters were significantly more likely to be completed (72% vs. 50%) and less likely to be canceled (21% vs. 46%) compared with in-person encounters. Conclusions: Telemedicine services facilitated continued access to gender-affirming care services for TGD youth during the COVID-19 pandemic. Although the introduction of telemedicine did not exacerbate demographic disparities in access to this care, further research and interventions are warranted to address the ongoing disparities in access to gender-affirming care for youth of color and rural youth.

Telemedicine preferences in pediatric urology following the COVID-19 pandemic: A caregiver survey

PurposeThe COVID-19 pandemic dramatically changed the way many patients interacted with their healthcare providers, with many people being forced to use telemedicine out of necessity. Our study aimed to investigate if this increased usage of telemedicine impacted pediatric patient caregivers’ perception of telemedicine for pediatric urology visits.Materials and MethodsA prospective survey was administered to the primary caregiver of all patients less than 18 years of age during either an in-person (IP) or a telemedicine (TM) encounter. The survey included questions regarding accessibility to and opinions toward telemedicine.ResultsTwo hundred, thirty-nine total patient caregivers were surveyed: 209 IP and 30 TM. Most caregivers in both cohorts reported being more likely to use telemedicine now than before the pandemic: IP (125/209, 59.8%) and TM (23/30, 76.7%). Caregivers also reported that the severity of their child’s condition would impact their likelihood to utilize telemedicine for evaluation (IP 162/209 (77.5%) vs. TM 28/30 (93.3%) with caregivers in the TM group even more likely to be influenced by this factor (p = 0.045). Most caregivers in both groups reported that they would utilize telemedicine within 60 miles from the provider. Over 80% of families from both groups reported having both a laptop and a cellular phone in their home. A greater percentage of caregivers in the IP group reported having a desktop computer and a tablet in their home compared to the TM group (41.1% versus 20.0% and 27.3% versus 3.3%, respectively).ConclusionsLiving through the COVID-19 pandemic has increased the likelihood of caregivers to utilize telemedicine for care of their child’s pediatric urologic disorder. Factors such as severity of illness, distance from the provider, and the context of the evaluation influenced caregiver preferences for utilization of telemedicine. All families surveyed reported having a device at home to perform telemedicine. Laptops and cellular phones were the most commonly used devices.

Abstract WP23: Stroke Survivors Experience During The Covid-19 Pandemic: A Phenomenological Investigation

Background and Purpose: Stroke occurs suddenly and can be a life-changing experience. Nearly 800,000 people in the United States each year suffer a stroke leading to major disability. Support of treatment of acute and follow-up care involves complex, evidence-based interventions to reduce death, stroke recurrence, post stroke disability and risk factors management. In 2019, American Heart Association released a policy guiding implementation of stroke systems of care. However, COVID-19 pandemic lockdowns changed public perceptions of when to seek stroke care. Little is known about care transformation due to pandemic. This study describes stroke survivors lived experience and challenges faced while seeking post-stroke care during pandemic across. Methods and Analysis: A qualitative phenomenological methodology was used to conduct the study. We enrolled 15 participants who had telemedicine follow-up visits and conducted in-depth interviews using study guide. Two independent reviewers used Giorgi descriptive method to search for essence of lived experience of surviving stroke and themes related to follow-up care using telemedicine. Results: Lived experience included variety of reactions due to an acute event such as life uncertainly, confusion and frustration, loneliness and worries. Unexpected challenges of care access and quality due to special COVID protocols and limited or no family support during hospital stay, emerged as additional themes. Themes related to follow-up care included post-stroke care coordination challenges, pros and cons of telemedicine encounters and practical aspects of using technology. Conclusions: Having a stroke during pandemic, created unexpected challenges that transformed post-stroke care. Individual approach was most important in dealing with challenges. Positive changes occurred while using telemedicine except in cases where full medical exam was needed. Patients recommended using hybrid approach for post-pandemic visits (in-person and telemedicine). Knowledge gained from this study can be used in a wider context of limitations imposed by other civilization-related epidemics.

Pre-Paid Phone Distribution: A Tool for Improving Healthcare Engagement for People with Substance Use Disorder

Background The COVID-19 pandemic drove significant disruptions in access to substance use disorder (SUD) treatment and harm reduction services. Healthcare delivery via telemedicine has increasingly become the norm, rendering access to a phone essential for engagement in care. Methods Adult patients with SUD who lacked phones (n = 181) received a free, pre-paid phone during encounters with inpatient and outpatient SUD programs. We evaluated changes in healthcare engagement including completed in-person and telemedicine outpatient visits and telephone encounters 30 days before and after phone receipt. We used descriptive statistics, where appropriate, and paired t-tests to assess the change in healthcare engagement measures. Results Patients were predominantly male (64%) and white (62%) with high rates of homelessness (81%) and opioid use disorder (89%). When comparing 30 days before to 30 days after phone receipt, there was a significant increased change in number of telemedicine visits by 0.3 (95% CL [0.1,0.4], p < 0.001) and telephone encounters by 0.2 (95% CL [0.1,0.3], p = 0.004). There was no statistically significant change in in-person outpatient visits observed. Conclusions Pre-paid phone distribution to patients with SUD was associated with an increased healthcare engagement including telemedicine visits and encounters.

Piloting a novel medical student virtual discharge counseling process in the time of the COVID-19 pandemic

Background During the COVID-19 pandemic, we identified a gap in adequate discharge counseling for COVID-19 patients in the Emergency Department. This was due to high patient volumes and lack of patient education regarding a novel disease. Medical students were also restricted from clinical areas due to safety concerns, compromising their clinical experience. We piloted a novel program in which medical students served as virtual discharge counselors for COVID-19 patients via teleconference. We aimed to demonstrate an impact on patient care by examining the patient bounce back rate as well as assessing medical student education and experience. Methods This program was piloted in a tertiary care Emergency Department. Medical student volunteers served as virtual discharge counselors. Students were trained in discharge counseling with a standardized protocol and a discharge script. Eligible patients for virtual discharge counseling were 18 years old or greater with a diagnosis of confirmed or suspected COVID-19 and no impediment precluding them from participating in a telemedicine encounter. Counseling was provided via secure teleconference in the patient's preferred language. Counseling included diagnosis, supportive care with medication dosing, quarantine instructions, return precautions, follow up, and time to ask questions. Duration of counseling was recorded and medical students were anonymously surveyed regarding their experience. Results Over an 18-week period, 45 patients were counseled for a median of 20 min. The 72-hr ED revisit rate was 0%, versus 4.2% in similarly-matched, not counseled COVID-19 patients. 90% of medical students believed this project increased their confidence when speaking with patients while 80% indicated this was their first telemedicine experience. Conclusion Our pilot discharge program provided patients with an extensive discharge counseling experience that would not otherwise be possible in an urban ED setting and demonstrated benefit to patient care. Medical students received a safe clinical experience that improved their communication skills.

Adapting an Objective Structured Clinical Examination (OSCE) on Conducting Difficult Conversations Between Nephrology Fellows and Patients to a Virtual Platform: A Research Letter

We previously described a nephrology-specific "Breaking Bad News" Objective Structured Clinical Examination (OSCE) assessing nephrology fellow communication and counseling skills in 3 scenarios: kidney replacement therapy (KRT) in kidney failure, urgent KRT in acute kidney injury (AKI), and kidney biopsy (KBx). The main objectives of this study is to adapt the OSCE to a virtual platform, simulating nephrology patient telemedicine encounters involving difficult conversations, and to assess fellow and faculty satisfaction with the virtual format. Description of a formative telemedicine simulation for nephrology fellows. Fully virtual simulation conducted by 2 academic medical simulation centers. Nephrology faculty and fellows at 3 urban/suburban training programs in the eastern United States. Description of the virtual OSCE process. Fellow and faculty satisfaction overall and for each scenario. Faculty and fellow estimates of frequency of virtual patient encounters in the past year. The OSCE consisted of 3 scenarios: KRT in kidney failure, urgent KRT in AKI, and KBx. Objective Structured Clinical Examinations were administered in May 2021. Each scenario lasted 20 minutes. The AKI scenario was audio only. Fellows telephoned a simulated patient surrogate for urgent KRT consent. Kidney failure and KBx scenarios were video encounters. Faculty observed while muted/video off. Immediately after the OSCE, fellows and faculty were anonymously surveyed regarding their satisfaction with each scenario, the OSCE overall, and their estimate of outpatient encounters and inpatient KRT counseling done virtually in the preceding year. Seventeen fellows completed the OSCE at 2 centers (3 programs). Sixteen (94%) completed the survey. Almost 94% rated the OSCE as a good/very good approximation of telemedicine encounters. Those satisfied/very satisfied with each scenario are as follow: 100% for AKI, 75% for kidney failure, and 75% for KBx. Two commented that they often did urgent KRT counseling by telephone. Fellows estimated a median 20% (interquartile range: 175, 50%) of counseling for acute inpatient KRT and a median 50% (IQR: 33.75, 70%) of outpatient encounters were virtual in the prior year. Two (regarding the kidney failure and KBx scenarios) indicated they would not have counseled similar outpatients virtually. The 15-minute interactions may be too short to allow the encounter to be completed comfortably. A small number of programs and fellows participated, and programs were located in urban/suburban areas on the east coast of the United States. Overall, fellows felt that the OSCE was a good approximation of virtual encounters. The OSCE is an opportunity for fellows to practice telemedicine communication skills.

Establishing a telemedicine program for interventional radiology: a study of patient opinion and experience.

PURPOSE The COVID-19 pandemic forced healthcare officials to implement new policies, such as the use of virtual consultations over office-based medical appointments, to reduce the transmission of the virus. The purpose of this study is to quantitatively compare patients' experiences with virtual outpatient telemedicine encounters at a single academic institution in Interventional Radiology (IR) and in-person visits during the course of the COVID-19 pandemic. METHODS The TeleENT Satisfaction Questionnaire and the Medical Communication Competence Scale (MCCS) were used to survey patients' satisfaction with both in-person and virtual office visits. RESULTS Ninety respondents (38 in-person, 52 virtual) acknowledged numerous benefits of virtual visits versus in-person office visits including reductions in time, cost, and potential viral transmission risk during the COVID-19 pandemic. No statistically significant difference was noted, based on a Likert scale from 1 to 7, between in-person and virtual visits (all p > 0.05) for scheduling related factors. No statistically significant difference was noted in any of the MCCS subscales between the two cohorts in regards to medical information communication (all p > 0.05). A majority of patients with virtual encounters (82.7%) stated that it was easy to obtain an electronic device for use during the telemedicine visit, and 73.1% of patients felt that setting up the telemedicine encounter was easy. CONCLUSION This study demonstrates that telemedicine is an acceptable alternative to in-office appointments and could increase access to IR care outside of the traditional physician-patient interaction. With telemedicine visits, patients can communicate their concerns and obtain information from the doctor with noninferior communication compared to in-person visits.

Use of Telemedicine Among People with Multiple Sclerosis Before and During the COVID-19 Pandemic.

Introduction: Multiple sclerosis (MS) is the most common progressive neurological condition with onset in young adulthood. Because people with MS (PwMS) are often separated from specialty care by distance or disability, telemedicine can help alleviate that burden by removing obstacles to accessing care. Methods: We surveyed 762 PwMS in the iConquerMS research network about their use of in-person and telemedicine services prepandemic (January-February 2020) and during the coronavirus disease 2019 (COVID-19) pandemic (September-November 2020). The survey asked PwMS about their use of in-person and telemedicine services, technology access, perceptions and preferences of telemedicine, their most recent telemedicine encounter, and reasons for not using telemedicine. Results: Prepandemic, the most cited reason for not using telemedicine was providers not offering remote visits. During the pandemic, there was a decrease in the use of in-person health care (100% to ∼78%) and an increase in telemedicine utilization (25% to ∼80%). Most participants had access to telemedicine-enabling technologies and a large portion indicated a preference for using telemedicine for some or most/all of their MS health care (41-57%). Before the pandemic, telemedicine utilization was highest for primary care, while during the pandemic, utilization of telemedicine was greatest for general MS care. Mental health telemedicine encounters increased during the pandemic. Discussion: The dramatic increase in telemedicine utilization during the COVID-19 pandemic has provided access for PwMS to multispecialty care. Maintaining the policy changes that enabled remote health care to expand during the pandemic will be critical for sustained access to MS specialty care for this vulnerable population.