ABSTRACT
Background: During the COVID-19 pandemic, the need for telehealth has come to the forefront of healthcare. In the right clinical context, telehealth is an easy and effective way for providers to deliver high quality care, while also taking away barriers to care access such as clinic inconvenience, distance traveled, financial toxicity, etc. An abundance of data exists regarding the benefits and potential of telehealth, but most data is from the perspective of the provider. Unfortunately, there is little information regarding the patient's perspective and satisfaction;and even less regarding accessibility issues in terms of technology and cultural perception of telehealth. We postulate that there is a need for individualized grass root level understanding of the population being served to make sure telehealth adoption is sustained and equitable. We are studying this using a rapid cycle improvement project using a Plan Do Study Act format (PDSA), with a cohort of veterans in a medical oncology clinic in Birmingham, AL. Methods: We spoke with a pilot cohort of 67 patients in the medical oncology clinic at the VA Medical Center in Birmingham, AL. Surveys were done on all patients prior to their initial telehealth visit. Patients first agreed to participate, and then answered a 6-question survey regarding their perception of telehealth, their willingness to participate, and their perceived barriers to participation. We then identified barriers to intervene upon, with the plan to engage senior VA Leadership for the same. Results: 67 medical oncology patients in the Birmingham VA between May 1 and May 31, 2020, agreed to participate in a survey prior to their first telehealth appointment. We found that of the 67 patients surveyed, only 48 (71.6%) had a video capable phone and only 41 (61.2%) had high-speed internet or data to support that call. Interestingly 25 patients (37%) did not feel they could access the video on their own phone. While this presented one barrier to telehealth, we also found that 11 patients (16.4%) would not want to participate in telehealth even if they had a video capable device. Conclusions: This data, while not exhaustive, clearly captures some unique barriers to telehealth that may not have been previously studied or understood. Hearing the voice of the patient is critical in developing culturally competent forms of telehealth delivery. We will use this data to implement interventions that not only provide access of technology for our patients but will also make sure to specifically address the cultural/socioeconomic barriers to this form of healthcare distribution and how to overcome those barriers.
ABSTRACT
Introduction: The SARS-CoV2 pandemic impacted numerous aspects of medical practice, including continuingmedical education. In-person and single-institution educational formats could not address the challenges of socialdistancing, heterogeneous regional experiences, and continuously emerging data. The vulnerability of cancerpatients to SARS-CoV2 added further urgency to overcoming these barriers. To fulfill these unmet educational andpatient care needs, we established a novel cross-institutional trainee-driven, on-line collaborative for the purpose ofgenerating multidisciplinary seminars on emerging best practices for the acute management of patients with SARS-CoV2. Methods: The COVID Learning Initiative is currently managed by clinical trainees and faculty from 13 institutionsacross 10 states. Weekly Zoom conferences were led by a rotating team consisting of 2-3 fellows overseen by 4-5expert faculty from throughout the country. Format consisted of two 15-minute instructional segments presented bytrainees, followed by a concluding 30-minute faculty Q&A panel moderated by a trainee. Attendees completedbaseline demographics, SARS-CoV2 experience surveys, and pre/post conference knowledge questions.Conferences were recorded and archived to enhance access and dissemination of knowledge. Results: Within 6 weeks and beginning just 2 weeks after inception we produced five 1-hour-longmultidisciplinary video conferences covering emerging antiviral therapies, coagulopathy, pulmonary complications, provider resilience, and ethics of resource scarcity. On average, there were 100 participants per seminar. Post-conference questioning consistently demonstrated acquisition of knowledge across topics and disciplines. Attendeesalso improved in their self-assessed comfort managing multidisciplinary aspects of SARS-CoV2. Overall, presentingcollaborations involved 11 fellows and 28 faculty representing 6 medical specialties and 17 institutions. Severalcollaborations persisted, resulting in further dissemination of knowledge with tangible outcomes such as generationof peer-reviewed manuscripts. Conclusions: The COVID Learning Initiative demonstrated a novel continuing medical education platform capableof rapidly disseminating knowledge at a national scale, while realizing new opportunities for remote traineementoring and skills development. With initial feasibility and continued interest among participating institutions, COVID Learning Initiative plans to evolve to Fellows ACHIEVE: Alliance for Collaborative Hematology OncologyInter-Institutional Education through Videoconferencing to conduct an extended multi-institutional educational serieson adapting cancer management and training program best practices.