Telemedicine For Patients Research Articles

Telemedicine and diabetes during the COVID-19 era.

The coronavirus disease 2019 (COVID-19) pandemic affected everyone’s life and especially those with chronic conditions, such as diabetes. Therefore, the need for medical care in such populations resulted in identification of new models of health care avoiding physical consultation and reducing the risk of COVID-19 transmission, giving emphasis to telemedicine. There is an increasing amount of studies showing the beneficial impact of the use of telemedicine in patients with type 1 diabetes, while for patients with type 2 diabetes the existing data are limited and conflicting. Therefore, the aim of the present review is to summarize the existing literature data on the impact of telemedicine on the follow-up of patients with diabetes during the pandemic as well as its place in the management of patients with diabetes in the future.

Telemedicine patient satisfaction metrics and methods of recurrence detection for gynecologic cancer patients throughout the initial year of the COVID-19 pandemic (515)

Objectives: To determine the patient satisfaction with telemedicine services throughout the initial year of the COVID-19 pandemic and evaluate detection of recurrence in those patients at a single, academic, tertiary-care medical center.Methods: Our Gynecologic Oncology clinic schedule was queried for all telemedicine encounters during the period of April 27, 2020- March 30, 2021. To assess patient satisfaction with telemedicine encounters, a modified 12-item Telemedicine Satisfaction Survey (TeSS) was administered to patients. Up to three contact attempts by phone were made for each patient. The exclusion criteria included patients requiring interpreter services. To analyze the initial method of diagnosis of recurrent gynecologic cancer during the COVID-19 pandemic, a retrospective chart review was completed on patients reached for survey completion.Results: Three hundred ninety-four patients were contacted. Three hundred sixteen completed the survey, and 78 declined, with a survey response rate of 80.2% (316/394). The mean age at cancer diagnosis was 60.1 years. The mean distance traveled from a patient’s home to the Gynecologic Oncology clinic was 50.4 miles. As detailed in Figure 1, personal comfort using telemedicine was rated as good or excellent by 90.8% of patients (n = 287). Almost 93.7% of patients felt that the explanation of treatment by the telemedicine staff was good or excellent (n=296). The courtesy, respect, sensitivity, and friendliness of staff during the telemedicine encounter was rated as excellent by 80.7% of patients (n=255). Of the 394 patients, 312 had pathologically-proven gynecologic malignancies. Of these patients, 9.3% (29/312) had recurrent gynecologic cancer during the study period. The initial method of recurrence detection included patient-reported symptoms (62.1%, n=18), routine biomarker (24.1%, n=7), and routine imaging (13.8%, n=4). Of the 364 patients, 72.6% used telemedicine for surveillance, 26.1% for postoperative visits, 11.7% for chemotherapy, 3.6% for problem visits, 1.3% for preoperative visits, and 0.5% for initial visits. Ultimately, 92.7% of patients rated their “overall treatment experience at using telehealth” as good or excellent (n=293). Telemedicine was well-received, with 87.0% of patients (n=275) indicating they would use telehealth again and 82.0% of patients (n=259) stating they would recommend telehealth to another gynecology oncology patient.Conclusions: With high patient acceptability, this study provides evidence to support the use of telemedicine as an option for gynecologic cancer surveillance in the post-pandemic period. Guided by patient health factors and preferences, telemedicine may be leveraged to reduce barriers to gynecologic specialty care such as distance traveled to the clinic while at the same time maximizing clinic capacity for patients necessitating in-person examination.

The use of telemedicine in pre-surgical evaluation: a retrospective cohort study of a neurosurgical oncology practice.

PurposeTo determine if there was a discrepancy between telemedicine versus in-person New Patient Visits (NPVs) regarding the conversion rate to operative and radiosurgery cases at a tertiary surgical neuro-oncology practice.MethodsA retrospective analysis was performed of patients who had an outpatient encounter with a neurosurgeon from the Tumor Division at our institution’s Department of Neurosurgery between February 1, 2021 and April 30, 2021. NPVs during this period were registered as either telemedicine or in-person appointments. The primary endpoint of the study was to compare the rate at which telemedicine NPVs and in-person NPVs underwent surgery or radiosurgery, reported as the surgical conversion rate.ResultsA total of 206 patients were included in this study. Of them, 119 (57.8%) were seen using telemedicine and 87 (42.2%) were seen in clinic via an in-person visit. A total of 70 (34%) of all patients underwent surgery or radiosurgery. Of the 119 patients seen via telemedicine, 40 (33.6%) underwent surgery or radiosurgery; during the same period, 87 NPVs were conducted in person and 30 (34.5%, p = 1.0) received an intervention. Further stratification revealed no differences between the two groups across measured criteria including diagnosis, number of pre-operative visits, elapsed time from appointment to surgery, follow-up visits, and distance from home address to neurosurgical clinic.ConclusionTelemedicine NPVs did not differ significantly from in-person NPVs when evaluating the likelihood of a new patient committing to surgical treatment. This study provides quantifiable evidence that telemedicine is an effective means of meeting new patients and planning complex neurosurgical interventions.

The long game: Telemedicine patient satisfaction metrics and methods of recurrence detection for gynecologic cancer patients throughout the initial year of the COVID-19 pandemic

ObjectiveThe primary aim of this study was to evaluate gynecologic cancer patients’ satisfaction with telemedicine visits over a one-year period during the COVID-19 pandemic. The secondary aim was to characterize how gynecologic cancer recurrence was detected with high telemedicine utilization. MethodsA survey study and a retrospective cohort study of patients participating in telemedicine visits between April 20, 2020 and March 30, 2021 in a gynecologic oncology clinic were undertaken. To assess patient satisfaction with telemedicine visits, the Telemedicine Satisfaction Survey (TeSS) was administered to patients by phone. Retrospective chart review was conducted to gather clinical data regarding diagnosis, treatment, and recurrence. ResultsThree hundred and sixteen patients completed the TeSS for a response rate of 80.2%. Patients rated the following aspects of the telemedicine encounter as good or excellent: quality of technology (97.8%), personal comfort (90.8%), length-of-visit (95.2%), treatment explanation (93.7%), overall experience (92.7%). Moreover, 87.0% of patients would use telemedicine again. Retrospective data was collected for 394 patients, 312 of which had invasive cancer (79.2%). Twenty-nine (7.4%) patients experienced a recurrence during the study period. The most common method of detection was patient-reported symptoms (n = 17, 58.6%). The remaining recurrences were diagnosed by scheduled biomarkers (n = 7, 24.1%), scheduled imaging (n = 4, 13.8%) and asymptomatic exam (n = 1, 3.4%). ConclusionsAfter one year of the COVID-19 pandemic and the implementation of routine telehealth visits, gynecologic cancer patients were overwhelmingly satisfied with the use of telemedicine. During this period, recurrences were most often diagnosed by patient-reported symptoms.

Predictors of telemedicine use during the COVID-19 pandemic in the United States-an analysis of a national electronic medical record database.

Telemedicine utilization increased significantly in the United States during the COVID-19 pandemic. However, there is concern that disadvantaged groups face barriers to access based on single-center studies. Whether there has been equitable access to telemedicine services across the US and during later parts of the pandemic is unclear. This study retrospectively analyzes outpatient medical encounters for patients 18 years of age and older using Healthjump–a national electronic medical record database–from March 1 to December 31, 2020. A mixed effects multivariable logistic regression model was used to assess the association between telemedicine utilization and patient and area-level factors and the odds of having at least one telemedicine encounter during the study period. Among 1,999,534 unique patients 21.6% had a telemedicine encounter during the study period. In the multivariable model, age [OR = 0.995 (95% CI 0.993, 0.997); p<0.001], non-Hispanic Black race [OR = 0.88 (95% CI 0.84, 0.93); p<0.001], and English as primary language [OR = 0.78 (95% CI 0.74, 0.83); p<0.001] were associated with a lower odds of telemedicine utilization. Female gender [OR = 1.24 (95% CI 1.22, 1.27); p<0.001], Hispanic ethnicity or non-Hispanic other race [OR = 1.40 (95% CI 1.33, 1.46);p<0.001 and 1.29 (95% CI 1.20, 1.38); p<0.001, respectively] were associated with a higher odds of telemedicine utilization. During the COVID-19 pandemic, therefore, utilization of telemedicine differed significantly among patient groups, with older and non-Hispanic Black patients less likely to have telemedicine encounters. These findings are relevant for ongoing efforts regarding the nature of telemedicine as the COVID-19 pandemic ends.

Telemedicine Patient Satisfaction Dimensions Moderated by Patient Demographics.

Background: A multi-dimensional telemedicine patient satisfaction measure is utilized to provide managerial insights into where service improvements are needed and factors that impact patient service perceptions. This research explores the influence of patient demographics on telemedicine satisfaction. Four dimensions of telemedicine patient satisfaction (health benefits, patient-centered care, monetary costs, and non-monetary costs) were compared across patient gender, income, and education levels. Methods: A survey of 440 US telemedicine patients on patient satisfaction was measured with Likert scale items to create a multi-dimensional construct using the SERVQUAL model. MANOVA, ANOVA, and linear contrasts were used to examine the impact of patient demographics on telemedicine satisfaction dimensions. Results: The findings revealed that patient demographic characteristics moderated various dimensions of their telemedicine experience satisfaction. Satisfaction with telemedicine health benefits was moderated by patient gender and income levels. Patient-centered care was moderated by patient gender, income, and education levels. Satisfaction with the monetary cost of telemedicine was associated with patient gender and education level. Patient education level influenced their satisfaction with telemedicine non-monetary costs. Discussion: Notable trends include generally higher patient satisfaction for women and those with lower education levels. Patient income showed mixed trends regarding the four dimensions of patient satisfaction. Improvements in patient health literacy along with customized services may improve telemedicine patient care satisfaction and health outcomes. Conclusions: Measuring telemedicine patient satisfaction with a multi-dimensional assessment tool provides insights into how patient demographics influence perceptions of services received. The findings highlighted perceptions of telemedicine patient satisfaction dimensions that differed across patient demographics and provided insights into their overall impact on telemedicine patient satisfaction.

Telemedicine adoption and utilization among financially distressed patients with cancer during the COVID-19 pandemic: Insights from a longitudinal nationwide survey.

1596 Background: Telemedicine use during the COVID-19 pandemic among financially distressed patients with cancer, with respect to the determinants of adoption and patterns of utilization, has yet to be delineated. We sought to systematically characterize telemedicine utilization in financially distressed patients with cancer during the COVID-19 pandemic. Methods: We conducted an analysis of survey data assessing the use of telemedicine in patients with cancer during the COVID-19 pandemic collected by Patient Advocate Foundation (PAF) from May 2020 to December 2020. Primary study outcome was telemedicine utilization rate. Secondary outcomes were independent predictors of telemedicine utilization patterns, volume, and utilization preferences. Multivariate and poisson regression analyses were used to identify predictive factors. Results: Of the 1,390 respondents, 627 completed two survey waves and were included in this study. Telemedicine adoption during the pandemic was reported by 67% of patients, with most (63%) preferring video visits. Younger age (odds ratio, 6.07; 95% CI, 1.47-25.1), and higher comorbidities (odds ratio, 1.79; 95% CI, 1.13-2.65) were independent predictors associated with telemedicine adoption. Younger age (19-35 yrs.) (incidence rate ratios [IRR], 1.78; 95%CI, 24-115%) and higher comorbidities (≥3) (IRR; 1.36; 95%CI, 20-55%) were independent predictors associated with higher utilization volume. As area deprivation index increased by 10 units, the number of visits decreased by 3% (IRR 1.03, 95%CI, 1.03-1.05). Conclusions: The rapid adoption of telemedicine may exacerbate existing inequities, particularly among vulnerable financially under-resourced patients with cancer. Policy-level interventions are needed for the equitable and efficient provision of this service.

P220 REMOTE MONITORING IN FOLLOW–UP OF ELDERLY PATIENTS WITH HEART FAILURE

Abstract Background Hospitalization is the home route after discharge of elderly patients with heart failure are associated with a high mortality rate (up to 50 % in the first six months) and repeated re–hospitalizations in the first three months, with a peak within thirty days of discharge despite therapy. Telehomecare offers concrete answers to the needs of specialized assistance, usable and in real time, but, on the other hand, the telematic follow–up lends itself to a considerable degree of distrust of non–traditional organizational models. Objectives The primary objective of this project is to evaluate the reduction of re–hospitalizations through a telematic follow–up by creating a low–cost virtual clinic. Secondary objective to assess the quality of life in the elderly large patient and the managerial continuity between hospital–home. MATERIALS AND Methods An initial narrative review of the literature was conducted by consulting the major data–bases available (Pub–Med, Chinhal and Cochrane Library) and then a qualitative survey of a sample of convenience of 31 users with an average age of 80,4 aa to assess the effectiveness of virtual follow–up . To assess the quality of life (qol) will be administered the questionnaire MLIHF Minnesota living with Heart Failure. The data will then be recorded on an excel sheet and analyzed through the R–Studio software. Results Through telemedicine interventions and teleconsultation has been achieved to a greater awareness of the health status of the patient and an empowerment of the selfcare that helps to ensure therapeutic adherence and to contain and/or avoid the progression of NYHA class, also improving the quality of life and the disconfort of travel Conclusions Home telemonitoring opens up new perspectives for chronically serious patients and shows potential benefits for patients‘ quality of life and cost containment. In our experience, the monitoring of telemedicine in patients with Heart Failure of high risk age (average age 80.4 years) will lead to an increased awareness of the disease, and the complete and specific training of the caregiver will become fundamental to build a solid social network system for the success of teledisease management.

Telemedicine and health care pathway of atrial fibrillation patient

Funding AcknowledgementsType of funding sources: None.BackgroundAmong cardiovascular diseases, atrial fibrillation is the most found arrhythmia in clinical practice and appears to have a significant impact on morbidity and mortality, which in turn represents a growing socio-economic burden for our health care system. COVID-19 pandemic has witnessed a pre-existing weakness of healthcare structures which has led to an irreversible collapse of hospitals’ performance and a turning point for the implementation of telemedicine.PurposeThe goal is to produce a literature review of applications and benefits which adoption of telemedicine in patients affected by atrial fibrillation could bring. The review presents implemented solutions in telemedicine field according to their respective key performance indicators (KPIs) to bring scientific evidence to papers and technological solutions.MethodsUsing PubMed electronic database, 47 articles were selected by entering keywords connected with both AF and Telemedicine and then skimmed-conducted through SCImago Journal Rank. They were divided into two AF-patient care pathways: diagnosis (18 articles) and follow-up (29 articles). The analysis was based on the key performance indicators KPI of several technologies proposed.ResultsSeveral innovative solutions implemented were found and that can be mainly clustered in two areas: wearables and apps for smartphone. For diagnosis, KPIs considered are accuracy(90,52-99,62%), sensitivity(62,5-100%), specificity(64,5-100%), PPV(64,7-95%) and NPV(95-100%). All these indicators show promising values. Regarding follow-up, KPIs are: adherence(70-99%), atrial fibrillation alert (AFA), specificity(83,3-100%), all-cause death, PPV (39,9-99,78%), sensitivity(98%), main adverse events (-3,3%), were calculated related to patient’s sphere; time investments, time to clinical decision in response to clinical events, unscheduled follow up and emergency admission of urgent follow-up were considered related to hospitals, while KPIs related to Healthcare system range of action are non-hospital and hospital costs, time rehospitalization and clinical follow-up and reduction in average hospitalization time. KPIs reveal an improvement in efficiency at a patient’s health status, hospitals, and health system level. Finally, some solutions have witnessed versatile functionality in both diagnosis and follow-up phases.ConclusionsMHealth devices show feasibility for the detection of AF since they promote mass screening of pathology and represent a user-friendly approach to monitor diseases by population. Diagnostic performance reported depends also on population attitude towards usefulness of that technology, their risk of AF, and kind of technology used. Follow-up revision reveals a broader perspective of results which remarkably declares the implementation of remote monitoring using multiple technologies through adherence to treatments, quantity, and quality of data available for the analysis of the progress of the patient.

Telemedicine utilization and patient satisfaction in an ambulatory movement disorders clinic during COVID-19 (P1-11.001)

Telemedicine utilization and patient satisfaction in an ambulatory movement disorders clinic during COVID-19 (P1-11.001)

Associations between Patient- and Provider Level Factors, and Telemedicine Use in Family Medicine Clinics.

Increased telemedicine implementation may promote primary care access. However, gaps in telemedicine uptake may perpetuate existing disparities in primary care access. This study assessed provider- and patient-level factors associated with telemedicine use in community-based family practice clinics. This retrospective study used electronic medical records data from a large Federally Qualified Health Center. A 3-level mixed-effects logistic regression model explored predictors of telemedicine use, with provider and patient as random effects. The analytic sample included 37,428 unique patients with 106,567 primary care encounters with 42 family medicine providers. Fifty-seven percent of the sample identified as Hispanic, 28% non-Hispanic White, and 11% non-Hispanic Black. Compared to Hispanics, non-Hispanic White patients had 61% higher odds of a telemedicine visit, and non-Hispanic Black patients had 32% higher odds of a telemedicine visit. The odds of telemedicine use were lower for those who were uninsured. Those residing in metropolitan areas or medically underserved areas had greater odds of a telemedicine appointment. Commute time exhibited a dose-response relationship with telemedicine use. Provider characteristics were not significantly associated with telemedicine use. While provider characteristics were not associated with telemedicine use, greater focus on patient characteristics specific to the population served is necessary.

Economic analysis of a pediatric neurosurgery telemedicine clinic.

The authors' objective was to compare the actual cost of a regional pediatric neurosurgery telemedicine clinic (PNTMC) with the estimated cost of a traditional physician-staffed outreach clinic. The authors' PNTMC was a partnership between the University of Florida College of Medicine-Jacksonville and Georgia Children's Medical Services to service the population of Georgia's Southeast Health District. Neurosurgeons based in Jacksonville conducted telemedicine visits with patients located at a remote site in Georgia with the assistance of nursing personnel from Children's Medical Services. The authors determined the actual annual per-patient costs at the Jacksonville and Georgia sites for fiscal years 2018 (FY18) and 2019 (FY19) and estimated the cost of providing traditional physician-staffed outreach clinics. During FY18 and FY19, the neurosurgery team conducted an average of 24.5 telemedicine patient encounters per year at a cost of $369 per patient visit. The per-patient cost was 32.5% less than the estimated per-patient cost of $547 at a traditional outreach clinic. The authors provided neurosurgical telehealth visits to appropriate patients, with a substantial cost savings per patient visit compared with traditional physician-staffed outreach clinics.

Implementation of diabetes care and educational program via telemedicine in patients with COVID-19 in home isolation in Thailand: A real-worldexperience.

BackgroundThe coronavirus disease (COVID‐19) outbreak in Bangkok led to a shortage of hospital capacity, and a home isolation system was set up. We described the process of diabetes self‐management education and support (DSMES) and glycemic management via telemedicine, along with outcomes in home‐isolated patients with COVID‐19 infection.MethodsA retrospective chart review of glucose values, insulin and corticosteroids use, and outcomes was performed.ResultsA volunteer group of 21 endocrinologists and 21 diabetes educators/nurses formed the consultation team. Patients with diabetes or at high‐risk of diabetes and receiving corticosteroids were referred by primary volunteer physicians. Glucometers and related supplies, and insulin were donated, and delivered via same‐day delivery services. A chat group of an individual patient/their caregiver, diabetes educator, endocrinologist, and primary physician was formed (majority via LINE® platform) to assess the patient's clinical status and need. Real‐time virtual DSMES sessions were performed and treatments were adjusted via smartphone application or telephone. There were 119 patients (1,398 service days), mean (SD) age 62.0 (13.6) years, 85.7% had a history of type 2 diabetes, and 84.0% received corticosteroids. Insulin was used in 88 patients; 69 of whom were insulin‐naïve. During the first 10 days, there were 2,454 glucose values. The mean glucose level on day 1 was 280.6 (122.3) mg/dL, and declined to 167.7 (43.4) mg/dL on day 10. Hypoglycemia occurred in 1.4% of the values. A majority of patients (79.5%) recovered at home.ConclusionDiabetes care and DSMES delivered via telemedicine to patients on home isolation during COVID‐19 pandemic was safe and effective.

Telemedicine for Patients with Chronic Pulmonary Diseases in the COVID-19 Era and Beyond.

Telemedicine for Patients with Chronic Pulmonary Diseases in the COVID-19 Era and Beyond.

Designing a Framework for Remote Cancer Care Through Community Co-design: Participatory Development Study.

BackgroundRecent shifts to telemedicine and remote patient monitoring demonstrate the potential for new technology to transform health systems; yet, methods to design for inclusion and resilience are lacking.ObjectiveThe aim of this study is to design and implement a participatory framework to produce effective health care solutions through co-design with diverse stakeholders.MethodsWe developed a design framework to cocreate solutions to locally prioritized health and communication problems focused on cancer care. The framework is premised on the framing and discovery of problems through community engagement and lead-user innovation with the hypothesis that diversity and inclusion in the co-design process generate more innovative and resilient solutions. Discovery, design, and development were implemented through structured phases with design studios at various locations in urban and rural Kentucky, including Appalachia, each building from prior work. In the final design studio, working prototypes were developed and tested. Outputs were assessed using the System Usability Scale as well as semistructured user feedback.ResultsWe co-designed, developed, and tested a mobile app (myPath) and service model for distress surveillance and cancer care coordination following the LAUNCH (Linking and Amplifying User-Centered Networks through Connected Health) framework. The problem of awareness, navigation, and communication through cancer care was selected by the community after framing areas for opportunity based on significant geographic disparities in cancer and health burden resource and broadband access. The codeveloped digital myPath app showed the highest perceived combined usability (mean 81.9, SD 15.2) compared with the current gold standard of distress management for patients with cancer, the paper-based National Comprehensive Cancer Network Distress Thermometer (mean 74.2, SD 15.8). Testing of the System Usability Scale subscales showed that the myPath app had significantly better usability than the paper Distress Thermometer (t63=2.611; P=.01), whereas learnability did not differ between the instruments (t63=–0.311; P=.76). Notable differences by patient and provider scoring and feedback were found.ConclusionsParticipatory problem definition and community-based co-design, design-with methods, may produce more acceptable and effective solutions than traditional design-for approaches.

Standardizing Quality of Virtual Urgent Care: Using Standardized Patients in a Unique Experiential Onboarding Program.

IntroductionVirtual urgent care (VUC) provides real-time evaluation, triage, and treatment of low-acuity medical problems; however, VUC physicians have varying levels of telemedicine training. We created a workplace-based experiential onboarding program that deployed standardized patients (SPs) into a VUC clinic to evaluate and deliver feedback to independently practicing physicians, providing quality assurance and identifying areas for improvement.MethodsWe simulated evaluation of an adult with upper respiratory symptoms. To replicate a real-life encounter, we developed a mock electronic medical entry with demographic and medical information and scheduled SPs into the clinic's actual patient queue. SPs provided seamless, realistic training within the real-world virtual clinic environment. Using an adapted assessment tool anchored to not done, partly done, or well done, SPs evaluated communication, disease-specific, and telemedicine skills by observing behaviors. We surveyed participants to evaluate the program.ResultsTwenty-one physicians participated. All performed well in core communication and disease management domains. Ninety-three percent of behaviors (SD = 11%) were rated well done within the information gathering domain, 90% (SD = 8%) within relationship development, and 95% (SD = 5%) within disease management. Physicians struggled with telemedicine-specific skills—55% (SD = 38%) well done—and education and counseling—32% (SD = 34%) well done—highlighting specific behaviors most ripe for improvement. All queried participants indicated that this simulation improved communication and telemedicine skills.DiscussionThis workplace-based experiential onboarding program uncovered knowledge gaps within telemedicine skills and patient education domains. Identification of these gaps can help drive new virtual care curricula.

A Systematic Implementation of Telemedicine in Singapore's COVID-19 Community Recovery Facilities.

Introduction: This article describes the experience of the Singapore Armed Forces (SAF) implementing telemedicine consultations for COVID-19-positive patients recovering within community recovery facilities (CRFs) in a semi-inpatient setting. Materials and Methods: The SAF adopted a systematic approach to telemedicine implementation and scaling up, with Phase 1 being the deployment of medical teams operating on-site clinics daily at six CRFs and telemedicine only provided for after-hours medical consultations on an ad hoc basis. Subsequently in Phase 2, most clinical consultations in the CRFs were conducted virtually. Results: Phases 1 and 2 recorded 1,902 and 449 clinical consultations, respectively. The mean number of clinical encounters was 33 per 1,000 occupants per day in Phase 1, and 12 per 1,000 occupants per day in Phase 2 (p < 0.001). Acute respiratory illness (52.3% in Phase 1 and 46.7% in Phase 2) was the most common reason for consultations. With full telemedicine in Phase 2, there was reduction in the mean number of clinical encounters per 1,000 occupants per day (p = 0.001), lower man-hours in personal protective equipment (PPE) (p < 0.001), and rise in escalation of care (p < 0.001) but without adverse events reported. Conclusions: Telemedicine for patients was safe, improved medical manpower efficiency, and reduced man-hours in PPE. The increased escalation of care in Phase 2 due to the lack of physical examination capabilities was to be expected to ensure patients' safety. Overall, it is recommended that for stable and mild medical conditions, telemedicine is a viable, safe, and efficient health care delivery tool in crisis situations similar to COVID-19.

Pros and Cons of Telemedicine for Inherited Metabolic Disorders in a Developing Country During the COVID-19 Pandemic.

Introduction: The COVID-19 pandemic has led to considerable changes in the health care system. Experts suggested that individuals protect themselves through social isolation during the pandemic, and consequently, the importance of telemedicine came to be understood for patients with chronic diseases. Telemedicine started to be used in developing countries where the appropriate infrastructure was lacking earlier. The present study investigates the level of satisfaction of patients with inherited metabolic disorders (IMDs) with telemedicine. Methods: This prospective study was conducted by making use of a new video appointment program that ensures the privacy of the patients in video-based consultations. The sociodemographic characteristics of the patients, their clinical status, their views on the telemedicine system, and their levels of satisfaction were questioned. Results: Overall, 174 patients were included in the study. The most common diagnoses were aminoacidopathies, lipid metabolism disorders, biotinidase deficiency, and lysosomal/peroxisomal diseases. More than half of the parents (67.6%) who lived in another city reported accommodation issues when coming to the hospital, and most believed telemedicine would save them time (93.1%) and money for travel (81.6%). The lack of laboratory and radiological tests (83.9%) was stated as the main disadvantage by most parents. Almost all the parents (96.6%) stated that they would opt for telemedicine if it became available in daily practice. The overall satisfaction rate was 94.6 (±10.1)/100. Conclusions: The present research is the most extensive cohort study to date assessing telemedicine in patients with IMDs and it highlights the importance of telemedicine, especially in developing countries during the COVID-19 pandemic.

Treatment Interruptions and Telemedicine Utilization in Serious Mental Illness: Retrospective Longitudinal Claims Analysis.

BackgroundAvoiding interruptions and dropout in outpatient care can prevent mental illness symptom exacerbation and costly crisis services, such as emergency room visits and inpatient psychiatric hospitalization. During the COVID-19 pandemic, to attempt to maintain care continuity, telemedicine services were increasingly utilized, despite the lack of data on efficacy in patients with serious mental illness. Patients with serious mental illness are challenging to enroll and sustain in randomized controlled trials over time due to fluctuations in disease exacerbation. However, capturing and examining utilization and efficacy data in community mental health center (CMHC) patients with serious mental illness during the pandemic is a unique opportunity to inform future clinical and policy decision-making.ObjectiveWe aimed to identify and describe the characteristics of CMHC patients with serious mental illness who experienced treatment interruptions and who utilized telemedicine during the pandemic.MethodsWe conducted a retrospective observational study of treatment interruptions and telemedicine use during the period from December 2019 to June 2020 (compared to the period from December 2018 to June 2019) in New Hampshire CMHC patients. The study population included all Medicaid beneficiaries with serious mental illness engaged in treatment 3 months prior to the declaration of a state of emergency in response to the COVID-19 pandemic. We used chi-square tests of independence and logistic regression to explore associations between treatment interruptions and variables (gender, age, rurality, and diagnosis). Telemedicine utilization was categorized as low (<25%), medium (25%-75%), or high (>75%) use.ResultsA total of 16,030 patients were identified. New Hampshire CMHCs demonstrated only a 4.9% increase in treatment interruptions compared with the year prior. Patients who were male (odds ratio [OR] 1.27, 95% CI 1.17-1.38; P<.001), under the age of 18 years (ages 0-12 years: OR 1.37, 95% CI 0.62-0.86, P<.001; aged 13-17 years: OR 1.49, 95% CI 0.57-0.79, P<.001), or among milder diagnostic categories, such as anxiety disorders (OR 3.77, 95% CI 3.04-4.68; P<.001) and posttraumatic stress disorder (OR 3.69, 95% CI 2.96-4.61; P<.001), were most likely to experience treatment interruptions. Patients who were female (OR 0.89, CI 0.65-0.74), 18 to 34 years old (OR 0.74, CI 0.70-0.79), or among milder diagnostic categories, such as anxiety disorder (OR 0.69, CI 0.65-0.74) or posttraumatic stress disorder (OR 0.77, CI 0.72-0.83), and with major depressive disorder (OR 0.73, CI 0.68-0.78) were less likely to be in the low telemedicine utilization group.ConclusionsThe integration of telemedicine supported care continuity for most CMHC patients; yet, retention varied by subpopulation, as did telemedicine utilization. The development of policies and clinical practice guidelines requires empirical evidence on the effectiveness and limitations of telemedicine in patients with serious mental illness.

A Retrospective Analysis of Clinical Utilization Between Patients Who Used Telemedicine and Office Visits in Outpatient Physical Medicine and Rehabilitation Clinics During the COVID-19 Pandemic.

To describe the demographic characteristics of patients who used telemedicine and office visits in physical medicine and rehabilitation during the COVID-19 pandemic and to quantify differences in clinical utilization between groups. Clinical utilization was defined as emergency department, urgent care, and hospital visits. This was a retrospective cohort study of 1096 patients who used telemedicine and 1171 patients who used office visits from April to June 2020 in the outpatient physical medicine and rehabilitation clinics at University of Pittsburgh Medical Center for musculoskeletal-related complaints. The telemedicine groups contained proportionally more people of color and higher comorbidities than the office visit groups. Patients who were seen in the telemedicine groups were more likely to be prescribed opioids than the office visit group. There were no differences in clinical utilizations between the telemedicine and office visit groups. The higher use of telemedicine in patients of color suggests a need for studying long-term outcomes to evaluate differences in care standards. There is an urgent need to understand how telemedicine affects opioid prescribing practices. Lastly, future studies are needed to understand why there were no differences in clinical utilization between the telemedicine and office visit groups.