Utilization Of Telemedicine Research Articles

The utility of telemedicine in managing patients after COVID-19.

Despite growing knowledge about transmission and relatively wide access to prophylaxis, the world is still facing a severe acute respiratory syndrome coronavirus 2 (SARS CoV 2) global pandemic. Under these circumstances telemedicine emerges as a powerful tool for safe at-home surveillance after a hospital discharge; the data on when to safely release a patient after acute COVID-19 is scarce. Reckoning an urgent need for improving outpatient management and possibly fatal complications of the post-COVID period, we performed the pilot telemonitoring program described below. The study aimed to assess the usefulness of parameters and surveys remotely obtained from COVID-19 convalescents in their individual prognosis prediction. Patients were involved in the study between December 2020 and May 2021. Recruitment was performed either during the hospital discharge (those hospitalized in a Barlicki Memorial Hospital in Lodz) or the first outpatient visit up to 6weeks after discharge from another center. Every participant received equipment for daily saturation and heart rate measurement coupled with a tablet for remote data transmission. The measurements were made after at least fifteen minutes of rest in a sitting position without oxygen supplementation. Along with the measurements, the cough and dyspnea daily surveys (1-5 points) and Fatigue Assessment Scale weekly surveys were filled. We expected a saturation decrease during thromboembolic events, infectious complications, etc. A total of 30 patients were monitored for a minimum period of 45days, at least 2weeks after spontaneous saturation normalization. The mean age was 55 (mean 55.23; SD ± 10.64years). The group was divided according to clinical improvement defined as the ≥ 10% functional vital capacity (FVC) raise or ≥ 15% lung transfer for carbon monoxide (TL,CO) rise. Our findings suggest that at-rest home saturation measurements below 94% (p = 0.03) correspond with the lack of clinical improvement in post-COVID observation (p = 0.03). The non-improvement group presented with a lower mean-94 (93-96)% versus 96 (95-97)%, p = 0.01 and minimum saturation-89 (86-92)% versus 92 (90-94)%, p = 0.04. They also presented higher variations in saturation measurements; saturation amplitude was 9 (7-11)% versus 7 (4-8)%, p = 0.03; up to day 22 most of the saturation differences reached statistical significance. Last but not least, we discovered that participants missing 2 or more measurements during the observation were more often ranked into the clinical improvement group (p = 0.01). Heart rate day-to-day measurements did not differ between both groups; gathered data about dyspnea and cough intensity did not reach statistical significance either. A better understanding of the disease's natural history will ultimately lead us to a better understanding of long COVID symptoms and corresponding threats. In this paper, we have found home oxygen saturation telemonitoring to be useful in the prediction of the trajectory of the disease course. Our findings suggest that detection of at-rest home saturation measurement equal to or below 94% corresponds with the lack of clinical improvement at the time of observation and this group of patients presented higher variability of day-to-day oxygen saturation measurements. The determination of which patient should be involved in telemedicine programs after discharge requests further research.

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.

Telemedicine Use for Oncology Clinic Visits at a Large Medical Center During the Onset of COVID-19.

Introduction: The COVID-19 pandemic created an unprecedented surge toward telemedicine. This project investigated oncology clinic telemedicine utilization across the Vanderbilt University Medical Center (VUMC) from January to October 2020. Poorer prognosis and care of oncology patients is expected to be associated with increased emergency department (ED) visits. Methods: January to October 2020 clinic visits were identified from the VUMC's Electronic Data Warehouse (EDW). Oncology patients were identified by ICD-10 code and their EDW ED visit data were extracted. Joinpoint piecewise linear regression evaluated trends in tele-oncology visits. VUMC ED visits were compared for patients who did versus did not use telemedicine for oncology clinic visits. A Welch's two-tailed t-test investigated differences in ED visits/patient between these cohorts (α < 0.05). Results: A sharp increase in tele-oncology clinic visits from January to April 2020 (Monthly Percent Change = 396.26%) was followed by a steady decrease from April to October 2020 (Monthly Percent Change = -20.93%). The difference between these two trends was significant (p < 0.002). Of 18 cancer sites, breast cancers had the highest proportion (29.04%) of tele-oncology visits. There was no significant difference in January to October 2020 ED usage for oncology patients who did (0.40 ED visits/patient) versus did not (0.38 ED visits/patient) utilize telemedicine (p = 0.69). A total of 9.64% of oncology clinic visits from January to October 2020 were telemedicine visits, just below the 13.0% institutional average. Discussion: At the VUMC, tele-oncology spiked in March and April 2020 before decreasing from April to October 2020. Breast cancer clinics were most likely to use tele-oncology. Telemedicine use was not associated with increased ED visits for oncology patients, suggesting telemedicine as an alternative for routine oncology clinics. Oncology clinic telemedicine usage was 18th-highest among 33 specialties at our institutions, and among the lowest of nonsurgical specialties.

Assessment of Primary Care Physicians' Perception of Telemedicine Use During the COVID-19 Pandemic in Primary Health Care Corporation, Qatar.

While telemedicine has been extensively researched throughout the globe, the Middle East has seen relatively little research on the topic. The purpose of this study was to investigate the primary care physicians' perceptions of the use of telemedicine, as well as its hurdles and benefits, during the COVID-19 pandemic in the state of Qatar. In this multicenter cross-sectional study, an internally validated questionnaire was distributed among primary care physicians utilizing telemedicine during the pandemic at Primary Health Care Corporation (PHCC), the main primary care provider in Qatar. A convenience sample was taken due to the pandemic restrictions. Out of 254 analyzed questionnaires, about half of the physicians (48%) had used telemedicine in the past primarily in the form of telephone consultations. Nearly three-quarters (74%) of physicians agreed that telemedicine is an easy way to communicate during the pandemic, but only half (52%) felt it improved job performance and effectiveness. Most physicians (90%) agreed that telemedicine is safe during the pandemic, but opinion was split on whether an optimum assessment of COVID-19 disease could be conducted. The majority also considered telemedicine an effective tool for chronic disease reviews (63%) and other consultations such as blood test results and medicine prescriptions (71%). The most significant barrier to telemedicine use was a language barrier followed by a lack of proper training. About 79% of responders felt that telemedicine improves access to healthcare and assists in contacting difficult-to-reach individuals, and 74% also thought it minimizes no-shows in the clinics. Our study has shown that most physicians felt comfortable and safer using telemedicine as an alternative means to conduct consultations during the pandemic. Keeping in view its advantages, the majority suggested that it could be incorporated into daily practice even beyond the pandemic. However, concerns were raised about its use to assess COVID-19 disease, lack of training, and potential barriers such as language differences. Further studies are needed to assess the efficiency and cost-effectiveness of telemedicine as well as the evaluation of alternative media such as video consultation, which could increase the utility of telemedicine and potentially mitigate some of its disadvantages.

Effects of COVID-19 pandemic on the management of pulmonary hypertension

The coronavirus of 2019 (COVID-19) disrupted delivery of healthcare. Patients with pulmonary hypertension (PH), especially pulmonary arterial hypertension (PAH), require significant resources for both diagnosis and management and are at high risk for decompensation due to disruption in their care. A survey consisting of 47 questions related to the care of patients with PH was designed by the American College of Chest Physicians 2020–2021 Pulmonary Vascular Disease (PVD) NetWork Steering Committee and sent to all members of the PVD NetWork, as well as the multiple other professional networks for PH. Participation was voluntary and anonymous. Responses were collected from November 2020 through February 2021. Ninety-five providers responded to this survey. The majority (93%) believe that care of PH patients has been affected by the pandemic. Sixty-seven percent observed decreased referrals for PH evaluation. Prior to the pandemic, only 15% used telemedicine for management of PH patients compared to 84% during the pandemic. Telemedicine was used most for follow up of selected low-risk patients (49%). While 22% respondents were completely willing to prescribe new PAH therapy via telemedicine, 11% respondents were completely unwilling. Comfort levels differed based on type of medication being prescribed. Over 90% of providers experienced disruptions in obtaining testing and 31% experienced disruptions in renewal or approval of medications. Overall, providers perceived that the COVID-19 pandemic caused significant disruption of care for PH patients. Telemedicine utilization increased but was used mostly in low-risk patients. Some providers had a decreased level of comfort prescribing PAH therapy via telemedicine encounters.

The diagnostic test accuracy of telemedicine for detection of surgical site infection: A systematic review protocol.

Since the COVID-19 pandemic there has been a rapid uptake and utilisation of telemedicine in all aspects of healthcare. This presents a key opportunity in surgical site infection surveillance. Remote follow up methods have been used via telephone, with photographs and questionnaires for post-operative reviews with varying results. This review therefore aims to comprehensively synthesise available evidence for the diagnostic accuracy of all forms of SSI telemedicine monitoring. The protocol has been established as per both PRISMA-P (S1 Table) and the Cochrane handbook for reviews of diagnostic test accuracy. Medline, Embase, CENTRAL and CINAHL will be searched using a complete search strategy developed with librarian input, in addition to google scholar and hand searching. All study designs with patients over 18 and undergone a primarily closed surgical procedure will be eligible. Index tests will include all forms of telemedicine and a subgroup analysis performed for each of these. Comparative tests must include face to face review, and all reference standards will be included again for sub-group analyses. Search results will be screened by two investigators independently with a third providing consensus review on disagreements. Methodological quality will be assessed using the QUADAS-2 tool, first validated by two investigators as per the Cochrane handbook. Exploratory analysis will formulate summary receiver operating characteristic curves and forest plots with estimates of sensitivity and specificity of the included studies. Sources of heterogeneity will be identifying and investigated through further analysis. Potential benefits of telemedicine integration in surgical practice will reduce cost and travel time to patients in addition to avoiding wasted clinic appointments, important considerations in a peri-pandemic era. To avoid missed or further complications, there must be confidence in the ability to diagnose infection. This review will systematically determine whether telemedicine is accurate for surgical site infection diagnosis, which methods are well established and if further research is indicated.

Acceptability of Telemedicine in a Geriatric Outpatient Practice During the COVID-19 Pandemic.

Background: Telemedicine utilization has increased dramatically during the COVID pandemic. Few studies have evaluated the use and acceptability of telemedicine in older populations. This study examined the use and acceptability of telemedicine with older adults in an urban, geriatric practice. Methods: An anonymous survey was sent to patients seen at an urban, geriatric practice using MyChart in EPIC in March 2021. This population of patients is 55 years and older, 50% Black, 40% white, 3% Latino, 3% Asian, and 4% other. This panel is comprised of 71% Medicare, 23% non-Medicare/non-Medicaid, and 6% Medicaid. The total panel of patients includes ∼1,400 patients. The percent of patients on MyChart at the time of the survey was 78%. Thus, about 1,092 patients received the survey. Results: Of the 1,092 patients who received the survey, 247 (22.6%) responded. Around 80.37% of respondents rated their overall experience with telemedicine as good or excellent. Theme areas emerged around the advantages and disadvantages of telemedicine. A majority (70.28%) of respondents rated themselves as Somewhat Confident to Very Confident in use of telemedicine without family/friend assistance. A majority (74.16%) of respondents stated they plan to use telemedicine again. Conclusions: This survey demonstrated the feasibility and acceptability of telemedicine in an urban, geriatric population. A limit to this study is that the survey was administered on-line, so that participants may be biased regarding use of online technology. However, this study showed that the vast majority of older adults were confident in using telemedicine as an alternative to in-person visits during the COVID pandemic and plan on using it again.

Telemedicine utilization and perceived quality of virtual care among pregnant and postpartum women during the COVID-19 pandemic

Introduction The aim of this research was to examine the association between perceived quality of care during the COVID-19 pandemic and the modality of maternity care visits, virtual or in-person. Methods This study utilized an online nationwide survey about experiences in prenatal and postpartum care between 18 April and 6 August 2020. Perceived quality of care was categorized into worse care, better, or the same care as compared to before the pandemic. Barriers were categorized into five groups: (1) concern for the privacy of health information, (2) not having a private or quiet place, (3) lack of physical exam or measurements, (4) quality of care, and (5) technology issues. Data analyses included bivariate analyses and multivariate logistic regression. Results The majority (75.3%) of modified visits utilized telemedicine. Over half of the women took at-home measurements and the majority were successful. Barriers to care included a lack of a quiet or private space to conduct their visit. Women expressed concerns about a lack of measurements and a lower quality of care. Women who received telemedicine visits perceived worse care as compared to women who received in-person care visits (OR = 5.62; 95% CI 5.01–6.31). Discussion Previous studies have shown that pregnant patients are generally satisfied with virtual care during the pandemic. This study provides insight from a large nationwide sample of women and geographic variation in satisfaction and perceived quality. These findings highlight barriers and potential solutions to improving patients’ perceived quality of virtual maternity care, and thus future uptake of high-quality, virtual care.

INNV-24. PATIENT SATISFACTION AND COST ANALYSIS OF THE TELEMEDICINE PROGRAM WITHIN A NEURO-ONCOLOGY PROGRAM

Abstract Unique challenges exist in the utilization of telemedicine for neurological and surgical specialties. We examined the differences in patient satisfaction for telemedicine versus in-person Press Ganey survey reports within an integrated Neuro-Oncology Department to assess whether there was a difference between surgical and medical specialties. We also examined the potential cost savings benefits of utilizing telemedicine. 1189 Press Ganey surveys in the Department of Neuro-Oncology (982 in-person and 207 telemedicine) submitted by neurosurgical and neuro-oncology patients between 04/01/2020 and 06/30/2021 were analyzed. Survey results were divided into 4 categories (Access, Provider, Technology (for telemedicine only), and Overall Satisfaction). Results were compared between telemedicine and in-person visits, and by gender, age, insurance, and specialty. Potential time and cost savings were estimated by calculating lost productivity based on census income data with motor vehicle expenses, and round-trip distances with mean visit durations, respectively. The survey results demonstrated that, among telemedicine patients, there were no differences in satisfaction based on gender, age, or insurance. Surgical specialties scored higher in Access, Technology, and Overall. Among in-person patients, patients older than 65 had higher satisfaction for Provider (p=0.0368) and Overall (p=0.0010). Medicare patients returned higher scores compared to non-private insurance for Overall (p=0.0172). Surgical patients scored higher for Access (p=0.0002). When comparing Telemedicine to In-Person scores, In-person satisfaction was higher for Provider for all patients combined. For surgical patients only, Telemedicine scored higher only in Access (p=0.0252). Cost analysis demonstrated that patients saved an average of 155.4 to 175.1 miles and 3.1 to 3.4 hours of travel per visit and average cost savings were $117.84 to $185.00. We conclude that telemedicine lessens the financial and time burden on neuro-oncology patients and yields non-inferior patient-satisfaction when employed in neurosurgery as compared to medicine, despite potential limitations of the technology in neurological and surgical specialties.

Experience with Telemedicine in a Tertiary Academic Otologic Clinic During the COVID-19 Pandemic.

To examine the utility of telemedicine in a tertiary otologic practice. Retrospective case series. Tertiary neurotology clinic. Consecutive adult patients presenting via video visit between January 2020 and January 2021. Televideo modality to conduct visits with patients seeking evaluation for new concerns, second opinions, or routine follow-up for established conditions. Success of the televideo visit defined by the televideo visit being sufficient for determining a definitive plan and not requiring deferment of recommendations for a subsequent in-person visit. A total of 102 televideo visits were performed among 100 unique patients. Of those, 92 (90.2%) visits were for second opinions or evaluation of new concerns, most commonly for vestibular schwannoma (n = 32, 31.4%), followed by sensorineural hearing loss (n = 20, 19.6%). Other visits were conducted for early postoperative follow-up and established general follow-up. In 91.2% of cases (n = 93), patients were successfully evaluated and provided recommendations from the initial video visit. All visits with patients having a diagnosis of meningioma (n = 7), and nearly all with vestibular Schwannoma (97%, n = 31) and sensorineural hearing loss (95%, n = 19) were successful. Of the 79 patients offered surgery as one potential treatment option, 31 patients underwent surgery at our institution by time of review. Patients with unsuccessful visits (n = 9, 8.8%) were advised to schedule additional in-person diagnostic imaging, vestibular testing, or cochlear implant candidacy evaluation to establish a more definitive care plan. Virtual televideo visits were successful for a high percentage of selected patients seen at a tertiary neurotology practice, particularly those seeking evaluation of vestibular schwannoma or sensorineural hearing loss.

Utility and patient acceptance of telemedicine in nephrology.

There is an increasing burden of kidney diseases worldwide and access to specialist care is limited. Telemedicine, has been relatively less used in developing countries like India. The current study aims to assess the feasibility and acceptance of telenephrology services at our institute, a public hospital. A total of 150 patients were selected by stratified random sampling from the list of attendees who had undergone both in-person outpatient consultation and telenephrology consultation. Patient's attitude towards, and knowledge and acceptance of telenephrology services were evaluated. The average age of the study cohort was 42.52 ± 15.1years. More than one-third (39.3%) of our patients belonged to the lower middle socioeconomic class. The median distance traveled to reach our outpatient clinic was 113.5km (3-2249km). Patients reported lost workdays in 54.7% cases. The majority (95%) of patients managed to consult through teleservices successfully. Ninety percent of the patients gave a satisfaction score of 4 (out of 5) or above for their tele-consultation experience. The most important perceived benefit of teleconsultation was the reduced risk of infection (40.6%) followed by economic benefits (32%). The major disadvantage (36%) was the absence of physical examination. A combination of physical and telenephrology services was the option preferred by 84% of the patients. In developing countries like India, with the majority of the population residing outside major cities and with limited medical access, telenephrology has a huge potential to provide quality nephrology care to the remotest parts of the country.

Clinical and Sociodemographic Factors Associated with Telemedicine Engagement in an Urban Community Health Center Cohort During the COVID-19 Pandemic.

Objective: To examine chronic diseases, clinical factors, and sociodemographic characteristics associated with telemedicine utilization among a safety-net population. Materials and Methods: We conducted a retrospective cohort study of adults seeking care in an urban, multisite community health center in the Northeast United States. We included adults with ≥1 outpatient in-person visit during the pre-COVID-19 period (March 1, 2019-February 29, 2020) and ≥1 outpatient visit (in-person or telemedicine) during the COVID-19 period (March 1, 2020-February 29, 2021). Multivariable logistic regression models estimated associations between clinical and sociodemographic factors and telemedicine use, classified as "any" (≥1 visit) and "high" (≥3 visits). Results: Among 5,793 patients who met inclusion criteria, 4,687 (80.9%) had any (≥1) telemedicine visit and 1,053 (18.2%) had high (≥3) telemedicine visits during the COVID-19 period. Older age and Medicare coverage were associated with having any telemedicine use. Older and White patients were more likely to have high telemedicine use. Uninsured patients were less likely to have high telemedicine use. Patients with increased health care utilization in the pre-COVID-19 period and those with hypertension, diabetes, substance use disorders, and depression were more likely to have high telemedicine engagement. Discussion: Chronic conditions, older patients, and White patients compared with Latinx patients, were associated with high telemedicine engagement after adjusting for prior health care utilization. Conclusion: Equity-focused approaches to telemedicine clinical strategies are needed for safety-net populations. Community health centers can adopt disease-specific telemedicine strategies with high patient engagement.

Outpatient visit modality and parallel patient satisfaction: A multi-site cohort analysis of telemedicine and in-person visits during the COVID-19 pandemic

Telemedicine approaches provide many benefits to patients across both primary and specialty care. Patient acceptance is imperative to successful telemedicine implementation. As telemedicine utilization continues to surge, it is imperative that healthcare organizations have a method for evaluating the patient experience with these types of visits. Previous studies on experience with telemedicine have focused on smaller patient populations with narrow inclusion criteria and limited geographical reach. This research described how patients’ satisfaction with video telemedicine-based visits varied based on patient characteristics and how they compare with in-person visits. We obtained and analyzed results from standardized patient experience surveys to compare telemedicine and in-person clinic visits during the COVID-19 pandemic (between July 1, 2020, and June 30, 2021) across a diverse patient population. During the study timeframe, surveys were sent to 1,521,398 patients with a response rate of 20% (307,185). Our organization’s unique structure, size, and geographic spread allowed for a deeper and more comprehensive examination of telemedicine participants. Though a few trends emerged in the results, there were no significant differences in patient ratings of telemedicine visits and in-person clinic visits during the same period (p=0.672). This study demonstrated that patient satisfaction with telemedicine visits was non-inferior to in-person outpatient visits during the study timeframe.

LBSUN153 Trends In Diabetic Emergencies, A1c Monitoring And Telemedicine Utilization During The Covid Pandemic - A Cross Sectional Study

Abstract Introduction The COVID pandemic effects on the control of chronic diseases such as diabetes has been a growing concern. UK based studies have shown that during the pandemic, there were unfortunate reductions in A1c testing, an increase in diabetes related mortality, and an increased concern of subpar care in the outpatient setting. With the pandemic currently present in the US over a year, we retrospectively analyzed the trends of diabetic emergencies as it relates to A1c ordering frequency and telemedicine utilization. Methods Using the EPIC database, patients with type 1 and type 2 diabetes that were affiliated with the institution's primary care and endocrinology outpatient centers were selected. From this patient population, diabetes related ER visits/ admissions (hyperglycemia, DKA, HHS), A1c ordering frequency, average A1c and telemedicine utilization (telephone visits/ virtual visits) were reviewed under the following phases from January 1, 2019 - August 31, 2021: PRE-COVID (January 1, 2019 - February 29, 2020); COVID (March 1, 2020 - December 31, 2020) and VACCINATION (Jan 1, 2021 - August 31, 2021). Generalized linear models were used to assess the impact of COVID-19 on ED visits/admissions, telemedicine and A1c ordering frequency; while their numbers were compared between the three phases. Spearman correlation was used to assess correlation between variables of interest. Results A total of 10,083 patients were included in the study. There were statistically significant differences in the average monthly ED visits and admissions between the phases COVID and VACCINATION as compared to PRE-COVID with an average increase of 4 visits during COVID as compared to PRE-COVID (p = 0. 0061) and an average increase of 5 visits during VACCINATION as compared to PRE-COVID (p = 0. 0048). Telemedicine utilization increased by an average of 284 during COVID as compared to PRE-COVID (p &amp;lt; 0. 0001). On the other hand, there was a significant decrease in A1c ordering during the COVID phase as compared to PRE-COVID by an average of 294 (p = 0. 0003) which returned to similar ordering frequencies to PRE-COVID during the VACCINATION phase. Of note there were no statistically significant difference of average A1c throughout each phase. There was significant positive correlation between telemedicine visits and ED visits/ admission where hospital visits increased with increased telemedicine utilization (ρ = 0.49; p = 0. 0049) . On the other hand there was significant negative correlation between telemedicine and A1c ordering frequency (ρ = -0.46; p = 0. 0076). There was no significant correlation between ED visits/hospital admissions with A1c ordering frequency however. Conclusion Correlations between telemedicine utilization, hospital visits and A1c monitoring suggest a negative impact of telemedicine utilization on A1c monitoring and the frequency of acute diabetic complications during the COVID pandemic. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

Perceptions of telemedicine at a pediatric otolaryngology-head and neck surgery program

ObjectiveWith few studies investigating the effectiveness of telemedicine (TM) in pediatric otolaryngology (ear, nose, and throat; ENT), its role in clinical practice is unclear. The objective of this study was...

Telemedicine and health disparities: Association between patient characteristics and telemedicine, in-person, telephone and message-based care during the COVID-19 pandemic.

Telemedicine has been an essential form of care since the onset of the COVID-19 pandemic. However, telemedicine may exacerbate disparities for populations with limited digital literacy or access, such as older adults, racial minorities, patients of low income, rural residences, or limited English proficiency. From March 2020 to March 2022, this retrospective cohort study analyzed the use of in-person, phone/message, and telemedical care at a single tertiary care center in an oncology department. We investigated the association between economic, racial, ethnic, socioeconomic factors and forms of care, including in-person visits, telemedicine-based visits, and telephone/messages. The study results show that telemedicine utilization is lower among patients 65 and older, female patients, American Indian or Alaska Native patients, uninsured patients, and patients who require interpreters during clinical visits. As a result, it is unlikely that telemedicine will provide equal access to clinical care for all populations. On the other hand, in-person care utilization remains low in low-income and rural-living patients compared to the general population, while telephone and message use remains high in low-income and rural-living patients. We conclude that telemedicine is currently unable to close the utilization gap for populations of low socioeconomic status. Patients with low socioeconomic status use in-person care less frequently. For the disadvantaged, unusually high telephone or message utilization is unlikely to provide the same quality as in-person or telemedical care. Understanding the causes of disparity and promoting a solution to improve equal access to care for all patients is critical.

Patient satisfaction and cost savings analysis of the telemedicine program within a neuro-oncology department.

Unique challenges exist in the utilization of telemedicine for neurological and surgical specialties. We examined the differences in patient satisfaction for telemedicine versus in-person visits within a Neuro-Oncology Program to assess whether there was a difference between surgical and medical specialties. We also examined the potential cost savings benefits of utilizing telemedicine. 1189 Press Ganey surveys in the Department of Neuro-Oncology (982 in-person and 207 telemedicine) by surgical and medical neuro-oncology patients between 04/01/2020 and 06/30/2021 were reviewed. Survey results were divided into 4 categories (Access, Provider, Technology (telemedicine only), and Overall Satisfaction). Results were analyzed for the impact of telemedicine versus in-person visits, and gender, age, insurance, and specialty. Cost savings were calculated based on potential travel distance and lost productivity. Survey results from telemedicine visits demonstrated that patients with private insurance returned higher scores in the Provider (p = 0.0089), Technology (p = 0.00187), and Overall (p = 0.00382) categories. Surgical patients returned higher scores for Access (p = 0.0015), Technology (p = 0.0002), and Overall (p = 0.0019). When comparing telemedicine to in-person scores, in-person scored higher in Provider (p = 0.0092) for all patients, while in-person scored higher in Access (p = 0.0252) amongst surgical patients. Cost analysis revealed that telemedicine allowed patients to save an average of 4.1 to 5.6h per visit time and a potential cost savings of up to $223.3 ± 171.4. Telemedicine yields equivalent patient satisfaction when employed in surgical as compared to medical Neuro-Oncology patients with the potential to lessen the financial and time burden on neuro-oncology patients.

The Intention to Use Telemedicine by Surgical Patients in Response to COVID-19

Objective: This study explored patients’ intention to use telemedicine instead of traveling to a hospital during the current global COVID-19 crisis. The framework focused on the relationships between variables derived from the technology acceptance model and the extended unified theory of acceptance and use of technology model.Materials and Methods: Multistage sampling procedures were applied to recruit samples using nonprobability sampling methods. Adult patients who had undergone surgery at a university hospital participated; all were experienced in using online meeting applications and online payment services in their daily lives. Consent forms and online questionnaires were distributed via a Google Forms link.Results: Between October and December 2021, 502 patients undergoing procedures participated in the study. Five variables—social influence, trust, price, perceived usefulness, and perceived ease of use—significantly impacted intention to use. Perceived ease of use significantly impacted perceived usefulness, with a value of 0.679***. In addition, perceived ease of use indirectly influenced intention to use (impact value, 0.103***). Performance expectancy did not significantly impact intention to use, with an impact value of -0.012.Conclusion: The contributions of this study will enable developers, medical professionals, and marketers to improve telemedicine services to better satisfy patients undergoing surgery and increase their intention to use telemedicine. However, the performance expectancy aspect may not warrant patients’ intention. Additionally, the research is recommended on other potential variables influencing telemedicine utilization, such as psychological expectations, performance expectations, and technical conditions.

The Impact of Telemedicine on Indirect Patient Costs in an Outpatient Radiation Oncology Department

Purpose/Objective(s)Patients incur more than medical-related expenses when attending necessary consultation and follow-up visits, including time and travel costs. With the rapid integration of telemedicine in response to the COVID-19 pandemic, our department gained another tool that has the potential to reduce the financial burden of cancer care for our patients. The aim of this study was to estimate the indirect cost savings (time, travel costs, opportunity costs) resulting from the use of telemedicine at a large, academic radiation oncology outpatient clinic located in a densely populated suburban setting. We hypothesize that telemedicine provides time- and cost-savings for patients.Materials/MethodsAll telemedicine and in-person visits scheduled at our main outpatient clinic over a one-week period in June 2021 were retrospectively reviewed. Care visits with patients residing outside of the state were excluded. Travel distance and time calculations were estimated using Google Maps and based on patients’ reported home address. Travel cost was calculated using the IRS 2021 standard mileage rate of $0.56 per mile. Opportunity cost was calculated by multiplying round-trip travel time with estimated hourly wage, derived by median household income per census block group and in the context of a 40-hour work week. Annual projections were calculated by multiplying weekly cost savings by 52.ResultsA total of 156 patients had scheduled visits in our department over one week, 115 of which were via telemedicine. There was no difference in gender, race, ethnicity, and insurance status between telemedicine and in-person visits. Those attending telemedicine vs in-person visits were younger in age (61 vs 68 yrs, p=0.03). There was no significant difference between distance or time traveled to the cancer center between telemedicine and in-person cohorts. For telemedicine visits, median per-visit round-trip travel time saved was 66 minutes (IQR, 39-168 minutes) with a travel cost savings of $33.60 (IQR, $17.92 - $100.80), opportunity cost savings of $67.04 ($42.97 - $118.56), and overall cost savings of $110.57 (IQR, $59.94 - $202.04). Annually, telemedicine visits are estimated to save patients a total travel time of 12911.6 hours, travel costs of $402,684, opportunity costs of $530,588, and overall cost savings of $933,272.ConclusionTelemedicine benefits patients with time- and cost-savings in an outpatient radiation oncology clinic. Our estimates are likely under-representative of the entire financial impact, as costs related to childcare, parking, tolls, hotels, and meals were not captured in our analysis. These unmeasured costs are likely amplified for those patients who live further from the clinic. Despite this, travel distance was not associated with utilization of telemedicine. In clinically appropriate situations, patient-centered metrics such time- and cost-savings should be considered when informing the choice between telemedicine and in-person visits.

Perioperative Telemedicine Utilization Among Geriatric Patients Being Evaluated for Abdominal Wall Reconstruction and Hernia Repair.

Introduction: Perioperative telemedicine services have increasingly been utilized for ambulatory care, although concerns exist regarding the feasibility of virtual consultations for older patients. We sought to review telemedicine encounters for geriatric patients evaluated at a hernia repair and abdominal wall reconstruction center. Methods: A retrospective review of telemedicine encounters between May 2020 and May 2021 was performed. Patient characteristics and encounter-specific outcomes were compared among geriatric (older than65 years old) and nongeriatric patients. Clinical care plans for encounters were reviewed to determine potential downstream care utilization. Patient-derived benefits related to time saved in travel time was calculated using geo-mapping. Outcomes for postoperative encounters were assessed to determine if complication rates differed between geriatric and nongeriatric populations. Results: A total of 313 telemedicine encounters (geriatric: 41.9%) were conducted among 251 patients. Reviewing preoperative factors for hernia care, geriatric patients presented with higher rates of recurrent or incisional hernias (87.9% vs. 70.7%, p < 0.01). Potential travel time was longer for geriatric patients (104 min vs. 42 min, p = 0.03) in the preoperative setting. No differences in clinical care plans were found. Only 8.6% of preoperative encounters resulted in recommendations for supplemental in-person evaluation. Operative plans were coordinated for 42.5% of all preoperative telemedicine encounters. There was no difference in complication rate between geriatric and nongeriatric patients (p > 0.05) in the postoperative setting, with no complications directly attributable to telemedicine-based care. Conclusions: Telemedicine-based evaluations appear to function well among geriatric patients seeking hernia repair and abdominal wall reconstruction. Clinical care plans rendered following telemedicine-based encounters are appropriate with a low rate of supplemental in-person evaluations. Telemedicine use resulted in significantly more time saved in commuting to and from clinic for geriatric patients.