ABSTRACT
OBJECTIVE: To evaluate patient experience with a prenatal telemedicine visit and identify barriers to accessing telemedicine among rural pregnant people in northern New England during the beginning of the COVID-19 pandemic. MATERIALS AND METHODS: We conducted a postvisit electronic survey of pregnant people who successfully participated in a prenatal telemedicine visit at a rural academic medical center in Northern New England. Nineteen questions were included in 5 domains: (1) engagement with prenatal care; (2) barriers to telemedicine and in person healthcare; (3) experience of prenatal care; (4) remote pregnancy surveillance tools; and (5) sources of COVID-19 information. RESULTS: Responses were obtained from 164 pregnant people. Forty percent of participants had participated in an audio-only telemedicine visit, and 60% in a video telemedicine visit. The visit was easy or somewhat easy for 79% of respondents and somewhat difficult or difficult for 6.8%. The most common barrier to accessing telemedicine was poor internet or phone connectivity, followed by childcare responsibilities, lack of equipment, and lack of privacy. Participants also engaged in additional remote prenatal care including phone calls with registered nurses (7.6%), communication with the obstetrics team through a secure health messaging portal (21.1%), and home health monitoring (76.3%). DISCUSSION AND CONCLUSIONS: In this survey, evaluating the experience of pregnant people participating in a prenatal telemedicine visit during the COVID-19 pandemic, respondents had a positive experience with telemedicine overall, but also identified significant barriers to participation including issues with connectivity and lack of equipment for the visit. Most participants used telemedicine in combination with other tools for remote self-care.
ABSTRACT
COVID-19 resulted in rapid implementation of telemedicine. It is critical to explore patient factors that drive telemedicine use to recognize any disparities in healthcare access that may emerge with remote healthcare. Our objective was to compare the characteristics and subsequent health care utilization of gynecologic oncology patients who had a scheduled telemedicine visit from 3/23/20-5/18/20. We conducted a retrospective study of women whose scheduled in-person office visits were converted to telemedicine. Video visits were encouraged and telephone visits were the default option. We compared patient factors between women who cancelled versus those who completed their telemedicine visits. Subsequent health care utilization included in-person office appointments, emergency department (ED) or operative care was compared between those who cancelled versus completed telemedicine visits. We also evaluated patient differences in completion of video vs telephone visits. Cancellation rates were compared to a historical control of in-person gynecologic oncology office visits (3/23- 5/18/19). Multivariate logistic regression analyses were performed to assess odds of completing a telehealth appointment. Of the 185 women with scheduled telemedicine visits, 158 (85%) completed and 27 (15%) cancelled. Telemedicine had significantly higher cancellations compared to office visits a year ago, 15% vs. 3% (p<0.001). Women who completed telemedicine visits tended to be older than those who cancelled (p=0.008). No other patient characteristics differed between those who completed versus cancelled telemedicine visits, and no differences were observed in subsequent health care utilization between groups. A total of 30% of patients had not activated their electronic patient portals prior to the study period. 124 (75%) of women had telephone visits. Being employed and a new, rather than established patient, was associated with video visits, p=0.009 and 0.003, respectively. In univariate analyses, older patients (OR 0.96;95% CI 0.93, 0.99) and Medicare insurance (OR 0.21, 95% CI 0.05, 0.90) were less likely to cancel a visit. No patient characteristics were associated with visit cancellation in multivariate analyses. [Display omitted] Telemedicine implementation faces ongoing challenges. High cancellation rates and patient's reluctance to use video or activate their electronic patient portals may limit a durable telemedicine platform. No patient characteristics were associated with the successful completion of telemedicine visits, and completion of telemedicine visits was not associated with subsequent healthcare utilization. More in-depth studies of patient engagement with telemedicine are needed to optimize healthcare delivery beyond the COVID-19 pandemic. [ABSTRACT FROM AUTHOR] Copyright of Gynecologic Oncology is the property of Academic Press Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
ABSTRACT
Post-operative morbidity can compromise patient outcome and require acute care services. Cancer patients who utilize the PRO-CTCAE - a standardized, validated method of capturing patient-reported outcomes (PROs) - to report their symptoms have been shown to reduce symptom burden, decrease the need for acute care, and preserve quality of life. Building off this work, a fully EHR-integrated PRO system capturing side effects from surgery could significantly improve health care delivery, particularly in rural populations which has been further challenged by the COVID-pandemic. Through the NCI's Moonshot-funded IMPACT consortium, Dartmouth-Hitchcock Medical Center (DHMC) in collaboration with 5 other health systems and Epic designed eSyM, an EHR-integrated electronic symptom management program based on the PRO-CTCAE questionnaire. eSyM was deployed at DHMC, a large rural academic medical cancer center, systems beginning in spring 2020, for gynecologic oncology patients having surgery. Prompts to complete questionnaires were disseminated via the standard DHMC Epic-based patient portal (MyChart) on a tapered schedule averaging approximately twice/week for 90 days after surgery. Each survey included at least 6 PRO-CTCAE symptom items including pain, nausea/vomiting, fatigue, anxiety, wound redness and discharge as well items assessing overall wellbeing and functional status. Composite scores were generated for each symptom: 0 for no symptoms, 1-2 for mild/moderate symptoms, and 3 for severe symptoms. Reported severe symptoms automatically prompted an alert message sent directly to nursing staff. Over the past 90 days, 134 women were eligible to participate in eSyM. 101 women were sent automated eSyM questionnaires after surgery through their patient portal. 69 (68%) activated their portal account and 48 (70%) completed at least 1 questionnaire electronically to report symptoms. Women who used eSyM were younger than those who did not activate their account, 54 vs. 61 years (p=0.05). Women completed a mean of 5 questionnaires over a mean of 19 days after surgery. 20% of patients reported severe symptoms, of which pain was the most common. Women who used eSyM were less likely to require hospitalization in the 90 days after surgery than women who did not participate (p<0.005). Urgent care and ED visits following surgery were comparable between eSyM users and those never activated their account Women with activated portal accounts had high rates of eSyM utilization to report symptoms after surgery. eSyM users tended to be younger than women who did not activate their accounts. Amidst the COVID-19 pandemic, an electronic platform to report and monitor symptoms following surgery alleviates some of the some of the burdens placed upon the patient and health care systems with in-person care, especially in rural settings. Future areas of research will include more robust patient cohorts from other institutions utilizing eSyM, and an evaluation of health care outcomes, including symptom burden, acceptability and acute care needs associated with eSyM. [ABSTRACT FROM AUTHOR] Copyright of Gynecologic Oncology is the property of Academic Press Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)