Telehealth Services Research Articles

Comparing the trends of MBS telepsychiatry and consultant physician telehealth services from 2017 to 2022: A retrospective study.

The Medicare Benefit Schedule (MBS) telehealth items were expanded in March 2020 during the COVID-19 pandemic. We measured the use of MBS telepsychiatry items compared to consultant physician telehealth items within the context of these item changes, to understand differences in telepsychiatry and physician telehealth utilisation. Monthly counts of face-to-face and telehealth (videoconferencing and telephone) MBS items for psychiatrists and physicians from January 2017 to December 2022 were compiled from Services Australia MBS Item Reports. Usage levels were compared before and after telehealth item expansion. Usage trends for MBS telepsychiatry and physician telehealth items were compared in time-series plots. Telehealth item expansion resulted in a greater rise of telepsychiatry services from 3.8% beforehand to 43.8% of total services subsequently, compared with physician telehealth services (from 0.6% to 20.0%). More physician telehealth services were by telephone compared with telepsychiatry services. Time-series of both telehealth services displayed similar patterns until mid-2022, when physician telehealth services declined as telephone items were restricted. Telepsychiatry services consistently comprised a greater proportion of total services than physician telehealth services. MBS psychiatrist services showed a more substantial and persistent shift to telehealth than physician services, suggesting a greater preference and use of telepsychiatry.

Telehealth adoption for substance use and mental health disorders in Minnesota and North Dakota: a quasi-experimental study.

The coronavirus disease 2019 (COVID-19) pandemic necessitated rapid adoption of telehealth services to maintain healthcare access for treating substance use disorders (SUDs) and mental health care (MHC). However, the impacts of telehealth expansion policies adopted in 2020 on access to addiction treatment in North Dakota (ND) and Minnesota (MN) remain unclear. This study examines the impact of the COVID-19 pandemic on utilization of telehealth services for SUDs and MHC in ND and MN. We conducted a quasi-experimental study design using Medicaid telehealth claims data from 2018 to 2022. Segmented regression analysis of interrupted time series (ITS) data was employed to assess the impact of the COVID-19 pandemic (March 2020) on telehealth service utilization. From 2018 to 2022, there were 580,186 telehealth claims for SUDs (MN: 545,676; ND: 34,510) and 3.4 million claims for MHC (MN: 3.3 million; ND: 85,391). The mean telehealth utilization rate for SUDs was 5.2 vs. 7.3 per 1,000 beneficiaries and for MHC was 12.6 vs. 45.2 per 1,000 beneficiaries in ND and MN, respectively. The pandemic led to significant increases in telehealth use: ND (SUDs: +22.7/1,000; MHC: +59.8/1,000) and MN (SUDs: +30/1,000; MHC: +185.5/1,000). ND saw smaller initial increases but more gradual declines over time (SUDs: -0.42/1,000/month; MHC: -1.03/1,000/month) compared to MN (SUDs: -0.43/1,000/month; MHC: -2.78/1,000/month). The COVID-19 pandemic significantly increased Medicaid telehealth utilization for SUDs and MHC in both states. MN experienced larger initial increases with steeper declines, while ND showed more sustainable utilization trends, indicating potential for sustained improvements in access to behavioral health services.

The impact of COVID-19 on time toxicity in patients with advanced cancer.

267 Background: The COVID-19 pandemic necessitated the rapid adoption of telemedicine but little is known about whether the changes in care delivery has led to differences in time toxicity for patients with advanced cancer. This study examines the impact of the pandemic on time toxicity, defined as the time burden of interacting with the healthcare system, by comparing healthcare contact days between pre-COVID and post-COVID periods. Methods: A retrospective cohort study was performed on patients with advanced (stage 4) cancer who died within one year of diagnosis at Kaiser Permanente Northern California between January 1, 2015 and June 30, 2023. Time toxicity was defined as the percentage of healthcare contact days over the course of survival period between cancer diagnosis and death (contact days/survival days). We included outpatient days (imaging, labs, treatment, provider visits), inpatient stays (emergency department, acute inpatient, non-acute institutional stays), and in-home days (in-home care, virtual care, home hospice). Differences between pre-COVID (diagnosed and died before March 1, 2020) and post-COVID (diagnosed after March 1, 2020) periods were analyzed using Wilcoxon tests. Results: The cohort included 9643 patients, with 6558 pre-COVID and 3085 post-COVID. Median age at diagnosis was 74 years, and the cohort was 46.9% female, largely white (64.5%), with a high comorbidity score (median Elixhauser score: 4). Post-COVID, there was an increase in institutional stay (8.7% vs. 9.3%) and outpatient service (imaging and labs) (4.4% vs. 3.1%), while in-person outpatient visits decreased (5.9% vs. 8.7%, p<0.0001). Additionally, in-home days increased (25.0% vs. 20.8%), with a significant rise in in-home virtual care (3.9% vs. 1.8%, all p<0.01). Conclusions: The COVID-19 pandemic led to notable shifts in healthcare utilization for patients with advanced cancer in the last year of life. The increase in telehealth and in-home services in the post-COVID era was accompanied by a slight increase in emergency and ancillary services. Further understanding patient experiences around these shifts is crucial for optimizing care and managing time toxicity in the evolving healthcare landscape. Description of outcomes pre and post-COVID-19 pandemic. Total Pre-COVID Post-COVID P-value Survival Days, median 86.0 84.0 89.0 0.02 Percentage of Contact, median (interquartile range) Comprehensive Contact 63.3 (41.0-92.0) 62.5 (40.7-91.0) 65.2 (41.7-94.1) 0.01 Institutional stay 9.0 (2.7-26.2) 8.7 (2.7-25.9) 9.3 (2.9-26.8) 0.11 Outpatient 12.4 (5.3-19.8) 12.9 (5.6-20.6) 11.2 (4.8-18.1) <.001 Outpatient visit 7.7 (2.8-13.4) 8.7 (3.5-14.6) 5.9 (1.6-10.7) <.0001 Outpatient service 3.5 (0.8-6.3) 3.1 (0.4-5.8) 4.4 (1.5-7.1) <.0001 In-home 22.2 (7.4-50.0) 20.8 (6.0-48.4) 25.0 (10.4-51.7) <.001 In-home care 18.1 (1.7-46.6) 17.4 (1.2-46.2) 19.2 (2.4-47.2) 0.03 In-home virtual care 2.2 (0.0-4.8) 1.8 (0.0-3.8) 3.9 (0.7-7.0) <.0001

Counseling self-efficacy in family play therapy telemental health services throughout the COVID-19 pandemic: A qualitative study.

Counseling self-efficacy in family play therapy telemental health services throughout the COVID-19 pandemic: A qualitative study.

Association of area-level broadband and non-small cell lung cancer diagnosis and guideline-concordant care in the US.

96 Background: Access to broadband is a social determinant of health facilitating connections with healthcare services and other resources and alleviating burdens of travel distance, time, and cost. We used nationwide data to examine the association of zip code-level broadband usage and stage at diagnosis, as well as the receipt of quality care among individuals newly diagnosed with non-small cell lung cancer (NSCLC). Methods: Individuals ≥18 years newly diagnosed with first primary NSCLC between April - December of 2019-2021, were identified from the National Cancer Database (January - March were excluded to match the COVID-19 timeframe in 2020). Broadband usage percentage (the percentage of individuals per zip code with access to fixed broadband at speeds of 25 Mbps/3 Mbps in 2020) were combined with the cohort based on individual’s residential zip code. Multivariable logistic regression models examined associations between broadband usage quartiles and stage at diagnosis, as well as the receipt of guideline-concordant care based on National Comprehensive Cancer Network guidelines, including surgery and radiation, ≥10 lymph nodes sampling, chemotherapy, and neoadjuvant chemoradiation (NACR). Analyses were conducted overall and stratified by metropolitan status and year, adjusting for age group, sex, race and ethnicity, comorbidity, distance to facility, state, and zip code-level social deprivation index (SDI). Results: Cohort included 305,198 individuals newly diagnosed with NSCLC. Individuals living in areas with the highest broadband usage were more likely to be aged 65-74 years, female, non-Hispanic White, with Medicare coverage, living in metropolitan and low SDI areas. In adjusted models, individuals living in areas with the highest broadband usage were more likely to be diagnosed with stage I NSCLC (adjusted odds ratio [AOR] = 1.10, 95% confidence interval [95%CI] = 1.01-1.20) and to receive guideline-concordant NACR (AOR = 1.38, 95%CI = 1.09-1.73) compared with those living in areas with the lowest broadband usage in 2020. When stratified by metropolitan status, associations of broadband and diagnosis and receipt of NACR were only observed among individuals living in non-metropolitan areas with medium-low and medium-high broadband usage, respectively (AOR = 1.15, 95%CI = 1.01-1.32; AOR = 1.80, 95%CI = 1.25-2.58). No significant associations were identified for other care modalities or during 2019 and 2021. Conclusions: Increased access to broadband usage is associated with earlier stage NSCLC diagnosis and receiving guideline-concordant NACR in 2020. Our results suggest that increased broadband access, combined with the expansion of telehealth services during the COVID-19 pandemic, may have improved telehealth utilization throughout 2020, leading to enhanced quality of cancer care, particularly benefiting individuals residing in non-metropolitan areas.

Embracing technological innovations in healthcare: An evaluation of a newly implemented dietetic telehealth service and strategies to improve technology acceptance and experience of patients and staff in Hong kong

Embracing technological innovations in healthcare: An evaluation of a newly implemented dietetic telehealth service and strategies to improve technology acceptance and experience of patients and staff in Hong kong

General practitioners' experiences delivering essential care services during the 2020 and 2021 COVID-19-related lockdowns.

The UK provided guidance for general practitioners (GPs) to deliver essential care services during the COVID-19 pandemic. Our objective was to describe local GP experiences and approaches to delivering care while similar formal guidance in Australia was unavailable. Two hundred and ninety-one GPs who practised during the March 2020 to December 2021 COVID-19 lockdowns in Melbourne and Sydney undertook an electronic survey exploring perceptions of essential care service delivery. The provision of care by Australian practices was compared to UK Royal College of General Practitioners' recommendations. Of 274 completed surveys, Australian GP practices were 60% concordant with UK guideline recommendations. There was a large shift towards telehealth service provision across the board, from diagnosis to follow-up. Most care continued if it was deliverable through telehealth or had urgent or time-sensitive need. Local guidance for delivery of essential care services should be developed for future calamities, informed by GPs' experience practising during the COVID 19 pandemic and considering Australian contextual factors.

Obstacles and enablers for using telehealth services online in nursing practice: A systematic review

Background: Comprehensive reporting on the barriers and enablers to telehealth adoption in industrialized nations has identified a wide range of significant factors. We aimed to get the important research information on the elements that nurses found most beneficial and hindering when using online telehealth services for nursing practice, we conducted a systematic review study. Method: This systematic review study was conducted in accordance with PRISMA principles. We searched for articles that discussed the aspects of using telehealth services for nursing practicum that nurse practitioners found most helpful and inconvenient. The international electronic databases that were used were Web of Science, Scopus CINAHL, and PubMed. The search was conducted for articles published in the period from 2011 and 2023. Only research that were written in English and published were considered. Results: We considered 7 articles in our systematic review analysis, totaling 3729 participants. Inadequate resources (time, money) were mentioned as barriers relevant to both organizational and patient issues. Negative attitudes, a lack of telehealth experience, and inadequate training and support were considered to be impediments to the use of telehealth (3). According to the findings of the Kleib et al., 2018 study, the following variables affect user competency and proficiency: age; Prerequisites for qualifying include prior knowledge of information technology and a sufficient, early, and continual informatics education. Conclusion: Numerous facilitators and obstracles were identified. In addition to administrative support, health professionals and information technology specialists must come to local agreements when transitioning from traditional face-to-face nursing practice to telehealth utilization.

Designing state-level policies to support independent pharmacies in providing specialty care services in rural regions

This review paper explores the critical role of independent pharmacies in rural regions, emphasizing their potential to deliver specialty care services despite facing significant challenges. These challenges include financial constraints, regulatory barriers, and limited specialized training and resource access. The paper argues that comprehensive state-level policies are necessary to support these pharmacies, enabling them to overcome these obstacles and enhance healthcare access in rural areas. Key policy recommendations include providing financial incentives such as grants and subsidies, regulatory reforms to streamline licensing processes and expand the scope of practice for pharmacists, and promoting partnerships between pharmacies, healthcare providers, and telehealth services. The paper also highlights the importance of integrating independent pharmacies into state health programs and adopting advanced technologies like telepharmacy and electronic health records. Future research directions are suggested, focusing on the impact of digital health technologies and evolving healthcare payment models on independent pharmacies in rural regions. The paper concludes by underscoring the need for targeted policy interventions to strengthen the role of independent pharmacies in rural healthcare, thereby improving health outcomes and quality of life for rural populations.

Clicks and checks: investigating the association between internet usage frequency and women’s uptake of clinical breast examination in Ghana

BackgroundIn resource-constrained settings, availability and access to mammography is a challenge. As such, the World Health Organization (WHO) recommends clinical breast examination (CBE) for women in such settings. Yet, CBE uptake remains low. We, therefore, aimed to contribute to the discourse on factors that influence women’s screening practice by investigating the association between the frequency of internet use and women’s uptake of CBE in Ghana.MethodsThis study was based on data from 15,013 women who participated in the 2022 Ghana demographic and health survey. We performed descriptive analysis, computed Pearson’s chi-square test, and fitted multivariable logistic regression models. The findings from the regression model were presented in adjusted odds ratio (AOR) at a 95% confidence interval.ResultsOnly 18.39% of women 15–49 years had their breasts examined by a healthcare provider. About 38.22% of the total sample often used the internet. Compared to women who did not use the internet at all, those who often used it had twice the odds of getting screened (COR = 2.86; 95%CI: 2.62–3.13). The odds of CBE uptake remained significantly higher among those who often used the internet (AOR = 1.26; 95%CI: 1.12–1.43) even after adjusting for the covariates.ConclusionWe conclude that CBE uptake is significantly high among women who frequently use the internet. This association persists even when considering other influential factors such as age, education level, marital status, and socioeconomic status. As such, it is imperative for the Ministry of Health in collaboration with the Ghana Health Service to recognize the potential of digital health interventions, including online health education campaigns and telehealth services, in reaching and engaging women to get their breast examined by a healthcare provider.

Secure messaging telehealth billing in the digital age: moving beyond time-based metrics.

We proposed adopting billing models for secure messaging (SM) telehealth services that move beyond time-based metrics, focusing on the complexity and clinical expertise involved in patient care. We trained 8 classification machine learning (ML) models using providers' electronic health record (EHR) audit log data for patient-initiated non-urgent messages. Mixed effect modeling (MEM) analyzed significance. Accuracy and area under the receiver operating characteristics curve scores generally exceeded 0.85, demonstrating robust performance. MEM showed that knowledge domains significantly influenced SM billing, explaining nearly 40% of the variance. This study demonstrates that ML models using EHR audit log data can improve and predict billing in SM telehealth services, supporting billing models that reflect clinical complexity and expertise rather than time-based metrics. Our research highlights the need for SM billing models beyond time-based metrics, using EHR audit log data to capture the true value of clinical work.

Why Do Patients Opt for the Emergency Department over Other Care Choices? A Multi-Hospital Analysis.

There are several options for receiving acute care besides emergency departments (ED), such as primary care physician (PCP) offices, urgent care centers (UCC), and telehealth services. It is unknown whether these alternative modes of care have decreased the number of ED visits for patients or whether they are considered before visiting the ED. A comprehensive study considering all potential methods of care is needed to address the evolving landscape of healthcare. Our goal was to identify any factors or barriers that may have influenced a patient's choice to visit the ED as opposed to a UCC, PCP, another local ED, or use telehealth services. We surveyed ED patients between three hospital sites in the greater Buffalo, NY, area. The survey consisted of questions regarding the patients' reasons and rationale for choosing the ED over the alternative care options. The study also involved a health record review of the patients' diagnoses, tests/procedures, consults, and final disposition after completion of the survey. Of the 590 patients consented and surveyed, 152 (25.7%) considered seeking care at a UCC, 18 (3.1%) considered telehealth services, and 146 (24.7%) attempted to contact their PCP. On the recommendation of their PCP, patients presented to the ED 110 (20.7%) times and on the recommendation of the clinician at the UCC 54 (9.2%) times. Patients' perceived seriousness of their condition was the most common reason for their selected mode of transport to the ED and reason for choosing the ED as opposed to alternative care sites (PCP, UCC, telehealth). Based on criteria for an avoidable ED visit, 83 (14.1%) ED patients met these criteria. Individuals prioritize the perceived severity of their condition when deciding where to seek emergency care. While some considered alternatives (PCP, UCC, telehealth services), uncertainties about their condition and recommendations from other clinicians led many to opt for ED care. Our findings suggest a potential gap in understanding the severity of symptoms and determining the most suitable place to seek medical care for these particular conditions.

Telehealth in Libraries: The Creation of a Novel Pre-Implementation Workbook

ABSTRACT Telehealth services are a growing aspect of the US healthcare delivery system. Some rural patients, however, lack proper internet speed in their home to access telehealth services and need alternative telehealth access points. Public libraries can be an alternative telehealth access point due to their access to high-speed internet services; however, these programs often experience limited success due to a lack of planning with community health providers and local health organizations. This article describes a novel workbook that guides public libraries to collaborate with community stakeholders when considering the implementation of telehealth services. Development of the workbook leveraged expertise of library and public health professionals. The workbook is currently free to download and updated versions will be available as more knowledge is gained in the field.

Designing A Blockchain-Empowered Telehealth Artifact for Decentralized Identity Management and Trustworthy Communication: Interdisciplinary Approach.

Telehealth played a critical role during the COVID-19 pandemic and continues to function as an essential component of health care. Existing platforms cannot ensure privacy and prevent cyberattacks. The main objectives of this study are to understand existing cybersecurity issues in identity management and trustworthy communication processes in telehealth platforms and to design a software architecture integrated with blockchain to improve security and trustworthiness with acceptable performance. We improved personal information security in existing telehealth platforms by adopting an innovative interdisciplinary approach combining design science, social science, and computer science in the health care domain, with prototype implementation. We used the design science research methodology to implement our overall design. We innovated over existing telehealth platforms with blockchain integration that improves health care delivery services in terms of security, privacy, and efficiency. We adopted a user-centric design approach and started with user requirement collection, followed by system functionality development. Overall system implementation facilitates user requirements, thus promoting user behavior for the adoption of the telehealth platform with decentralized identity management and an access control mechanism. Our investigation identified key challenges to identity management and trustworthy communication processes in telehealth platforms used in the current health care domain. By adopting distributed ledger technology, we proposed a decentralized telehealth platform to support identity management and a trustworthy communication process. Our design and prototype implementation using a smart contract-driven telehealth platform to provide decentralized identity management and trustworthy communication with token-based access control addressed several security challenges. This was substantiated by testing with 10,000 simulated transactions across 5 peers in the Rahasak blockchain network. The proposed design provides resistance to common attacks while maintaining a linear time overhead, demonstrating improved security and efficiency in telehealth services. We evaluated the performance in terms of transaction throughput, smart contract execution time, and block generation time. To create a block with 10,000 transactions, it takes 8 seconds on average, which is an acceptable overhead for blockchain-based applications. We identified technical limitations in current telehealth platforms. We presented several design innovations using blockchain to prototype a system. We also presented the implementation details of a unique distributed architecture for a trustworthy communication system. We illustrated how this design can overcome privacy, security, and scalability limitations. Moreover, we illustrated how improving these factors sets the stage for improving and standardizing the application and for the wide adoption of blockchain-enabled telehealth platforms.

“I would have to walk around to find the best Wi-Fi connection…”: qualitatively exploring challenges associated with rapid rollout of telehealth in Canadian long-term care homes

BackgroundEarly in the COVID-19 pandemic, long-term care (LTC) homes in British Columbia, Canada, restricted visitation to ensure the safety of their residents against transmission of the novel coronavirus. As such, these LTC homes had to quickly implement a rapid rollout of telehealth services to maintain physician care for residents while avoiding the infection risk of in-person visits amidst lockdown measures. The abrupt transition from traditional in-person physician care to telehealth presented significant challenges. Investigating these challenges is pivotal to the development of strategies for sustained telehealth use for physician services in LTC homes. This analysis is part of a broader qualitative, utilization-focused evaluation study of telehealth services rapidly implemented for physician care in LTC homes within the Fraser Health Authority region of British Columbia. The evaluation has aimed to consider integral factors such as telehealth challenges, facilitators, preferences, and continued use. Semi-structured interviews and focus groups were conducted with 70 physicians, staff, residents, and family caregivers across 27 different LTC homes in the region. All interviews and focus groups were transcribed verbatim and were analyzed using a thematic approach to identify common barriers surrounding the rapid rollout of telehealth in LTC across relevant groups.ResultsFrom the data, four challenges were identified: connectivity challenges (e.g., inconsistent or no Wi-Fi or cellular connectivity), device challenges (e.g., lack of accessible devices and software issues), privacy challenges (e.g., lack of private space to support telehealth use), and informational challenges (e.g., lack of electronic medical record access). All challenges posed barriers to telehealth access for both care provider and recipient groups in LTC settings.ConclusionsThe challenges identified in this analysis are supported by existing literature, which is significant given the different contexts within which such research has been undertaken. Collectively, this knowledge base can support evidence-informed improvements to telehealth for physician care in LTC settings. Future research should capture the perspectives of diverse cultural groups, LTC residents with cognitive impairments, and those who provide and receive care in rural settings.

Addressing the Digital Divide in Health Education: A Systematic Review.

The disparity in access to essential healthcare resources and services is exacerbated by the digital divide, which presents a significant obstacle to health education. Effective tactics to advance digital equity and provide equitable access to resources for telehealth and digital health are needed to close this gap. Digital databases such as PubMed, MEDLINE, Scopus, Web of Science, and Google Scholar were used to conduct a systematic review. Keywords and Boolean operators including "digital divide," "health education," "digital equity," "telehealth," "digital health literacy," and "strategies" were used in the literature search process. Only peer-reviewed English-language papers that addressed methods for bridging the digital divide in health education were accepted after being screened in accordance with the preset inclusion and exclusion criteria. The results were compiled using a narrative synthesis method after data were retrieved and synthesized with the aid of suitable quality assessment tools. After satisfying the inclusion criteria, seven papers were added to the systematic review. The results emphasized the complexity of the digital divide in health education and provided a range of approaches to mitigate disparities in access to digital health technologies and resources. The importance of digital equality and universal design, continuous intervention evaluation and monitoring, and enduring obstacles to Internet access and healthcare technology availability were among the major themes. This systematic study emphasizes how critical it is to put evidence-based tactics into practice in order to close the digital divide in health education. Through the promotion of universal design principles, ongoing evaluation of treatments, and digital equity, stakeholders can mitigate health disparities, improve population health, and guarantee equitable access to telehealth and digital health services.

Abstract A140: Stool-Based Colorectal Cancer Screening During the COVID-19 Pandemic in a Safety-Net Setting: A Mixed-Methods Study

Abstract Purpose: The COVID-19 pandemic resulted in a marked decrease in preventative screening services for colorectal cancer, especially for more involved procedures like colonoscopies. Nationally, some health systems turned to more socially distanced options such as fecal immunochemical tests (FIT) and guaiac fecal occult blood tests (gFOBT). This study aimed to examine the effects of pandemic protocols on FIT and gFOBT utilization in a large municipal safety-net setting. Methods: This mixed methods study examined primary care visits in Los Angeles County’s municipal safety-net system. Semi-structured interviews were conducted with key stakeholders at multiple levels of the organization. These insights were combined with analysis of structured Electronic Health Record data on orders and procedure codes for completed colorectal cancer screening, including screening colonoscopies and FIT/gFOBT tests within the Los Angeles County health system’s ambulatory care and hospital-based providers, in order to explore trends in colorectal cancer screening during the pandemic. Results: Pre-pandemic, stool tests such as FIT and gFOBT were already the dominant initial screening modality for colorectal cancer in the health system. Across the system, FIT/gFOBT rates decreased during the initial wave of the pandemic and took significant time to recover to pre- pandemic levels. System stakeholders noted significant challenges with utilization of stool sample modalities as a screening method during the pandemic, including poor return rates and patient hesitancy to come in person to receive or return tests. Efforts were made to improve upon utilization, for example implementing distribution of stool tests like the FIT via mail. Rates of screenings may also have been affected by the increase in use telehealth services during the pandemic, by which providers often communicated with patients to order FIT/gFOBT tests during the period. Conclusion: Socially distanced approaches to colorectal cancer screening were an attractive solution for safety-net health systems looking to continue preventative care efforts in a pandemic setting. Our study highlights unique challenges exacerbated by the pandemic that should be considered in the context of future utilization of these screening modalities. In the post-pandemic term, emphasis on FIT/gFOBT utilization, in combination with lessons learned during the pandemic, could help to overcome delays in screening precipitated by COVID-19 by decreasing barriers to access for vulnerable populations (e.g. transportation access, work flexibility) in comparison to endoscopy. Citation Format: Willow Pastard, Cameron Kaplan, Chun Nok Lam, Laura Solano, Sonali Saluja, Sarah Axeen, John Thacker, Todd Schneberk, Jennifer Tsui. Stool-Based Colorectal Cancer Screening During the COVID-19 Pandemic in a Safety-Net Setting: A Mixed-Methods Study [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A140.

Abstract C125: Improving access to genetic counseling and testing for underserved populations through telehealth

Abstract Introduction: A lack of access to genetic counseling for hereditary cancer risk in rural and underserved areas is well-documented and can exacerbate disparities in cancer risk reduction and early detection. Telehealth has the potential to bridge this gap, providing remote access to specialized care. The COVID-19 pandemic accelerated telehealth availability, allowing estimation of the causal effects of shifting to a model of virtual care delivery for genetic counseling services. Methods: The Stanford Cancer Genetic Counseling Clinic provided solely in-person care at two clinical sites (Palo Alto and San Jose, CA) until March 2020, and solely virtual care from April 2020 onward. We performed a regression discontinuity design, allowing outcomes comparison before and after the threshold of early 2020, to evaluate the impact of telehealth genetic counseling on access to care for patients living in areas of higher deprivation. The assignment variable (the exposure measured before versus after the threshold) was the three-month period during which the patients were seen, with the March-May 2020 quarter excluded because of disruption of care during the early COVID-19 pandemic. The primary endpoint was proportion of patients whose primary residence zip code had a state area deprivation index of at least 4. Secondary endpoints included driving distance to the primary clinic location in Palo Alto, CA, insurance type, race/ethnicity, and primary language. Results: The study included N=5,957 patients seen in the Stanford Cancer Genetics Program between January 2017 and February 2020, and N=9,469 patients seen between June 2020 and April 2024. The regression discontinuity analysis revealed a significant discontinuity at the threshold for telehealth in access for patients living in areas of higher deprivation, who accounted for 22% of patients seen just prior to telehealth implementation and 27% just after telehealth implementation, a proportional increase of 21% (p=0.006). Mean driving distance to Palo Alto, CA also increased, from 49 minutes just prior to the threshold to 56 minutes just after (p=0.003). There were no significant differences in insurance type, race/ethnicity, or primary language across the threshold. Conclusion: The implementation of telehealth services at the Stanford Cancer Genetic Counseling Clinic significantly improved access to genetic counseling for patients from areas with higher deprivation, as evidenced by a 21% increase in the proportion of such patients among those seen. These results quantify the effectiveness of telehealth in reducing geographical and socioeconomic barriers to specialized genetic counseling and testing services. Citation Format: Jennifer L. Caswell-Jin, Hao Tang, Mina Satoyoshi, Kerry Kingham, Allison W. Kurian. Improving access to genetic counseling and testing for underserved populations through telehealth [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C125.

Considerations of Medicare Telehealth Services With Older Adults

Considerations of Medicare Telehealth Services With Older Adults

Comparing Financial Efficiency and Quality of Care in Telemedicine, and Clinical Visits for Chronic Patients Registered in Primary Healthcare Centers of Makkah, Saudi Arabia

Primary healthcare plays a fundamental role in advancing public health, and the evaluation of its effectiveness is crucial part for ongoing enhancement and evolution. The escalating prevalence of non-communicable diseases is placing significant burden on the healthcare resources of both developed and developing countries. The aim of this study is to evaluate the financial efficiency and quality of care provided through telemedicine in virtual clinics compared to traditional clinical visits for chronic patients attending Primary Healthcare Centers (PHCs) in Makkah, Saudi Arabia. This research is using an analytical cross-sectional study design, and it included all adults registered in the HIS for 2023 with DM or HTN. The researcher compared in-person and virtual visit costs and some of the health outcomes. The study included 106,828 participants, with 392,441 visits to Primary Health Centers. The distribution was 52.12% male and 47.88% female, with 53.89% having DM and 46.11% HTN. Education level significantly influences visit preferences (p = 0.003), with higher educated participans evenly splitting between in-person and virtual visits, while those with no literacy favored in-person visits. Significant cost differences were observed between in-person and virtual visits (p < .001), with in-person visits incurring higher lab test counts and costs. In conclusion, our findings show that virtual visits and telehealth services have lower costs compared to the in-person consultations, with almost identical health outcomes for both groups. Which indicates that the virtual and in-person consultations have comparable quality.