Patient and caregiver experience with telepharmacy in cancer care to support beginning systemic therapy: A qualitative study.

INTRODUCTION: Although the COVID-19 pandemic spurred telehealth adoption for many specialties and care team roles, the patient and caregiver experience for telepharmacy visits has been relatively understudied. To our knowledge, there is a paucity of studies that have attempted to qualitatively evaluate this. This study aimed to qualitatively assess the patient and caregiver experience of telepharmacy visits in a cancer center. METHODS: Semistructured interviews were conducted with 21 patients with cancer and seven caregivers that had attended a telepharmacy visit between December 1, 2021, and May 24, 2022. The interviews assessed visit content, overall satisfaction, system experience, visit quality, and future preferences for pharmacy visits as telehealth versus in-person. We used both deductive and inductive coding to identify themes. RESULTS: Telepharmacy delivery was generally well-received. Reasons for having the telepharmacy visit included reviewing chemotherapy procedures, side effects to expect during treatment, providing education on recently prescribed medications, offering dietary recommendations (e.g., avoiding grapefruit juice), and performing medication reconciliation. Participants were receptive to having pharmacy visits through telehealth due to the perceived lack of a need to have a physical exam and prior relationship with the pharmacist. Participants also highlighted the main reason for the telepharmacy visits was primarily to provide patient education, which participants felt was suitable for telehealth. CONCLUSIONS: The patient and caregiver experience of telepharmacy is influenced by several factors, such as ease of connectivity, communicating effectively with the pharmacist, and timing of the telepharmacy visit (e.g., immediately after picking up medications from the pharmacy). Participants' recommendations to improve telepharmacy delivery included health systems raising awareness of telepharmacy services and providing a list of questions to patients to guide discussions.

Telemedicine Adoption in an NCI-Designated Cancer Center During the COVID-19 Pandemic: A Report on Patient Experience of Care.

BACKGROUND: Patients with cancer require timely access to care so that healthcare providers can prepare an optimal treatment plan with significant implications for quality of life and mortality. The COVID-19 pandemic spurred rapid adoption of telemedicine in oncology, but study of patient experience of care with telemedicine in this population has been limited. We assessed overall patient experience of care with telemedicine at an NCI-designated Comprehensive Cancer Center during the COVID-19 pandemic and examined changes in patient experience over time. PATIENTS AND METHODS: This was a retrospective study of outpatient oncology patients who received treatment at Moffitt Cancer Center. Press Ganey surveys were used to assess patient experience. Data from patients with appointments between April 1, 2020, and June 30, 2021, were analyzed. Patient experience was compared between telemedicine and in-person visits, and patient experience with telemedicine over time was described. RESULTS: A total of 33,318 patients reported Press Ganey data for in-person visits, and 5,950 reported Press Ganey data for telemedicine visits. Relative to patients with in-person visits, more patients with telemedicine visits gave higher satisfaction ratings for access (62.5% vs 75.8%, respectively) and care provider concern (84.2% vs 90.7%, respectively) (P<.001). When adjusted for age, race/ethnicity, sex, insurance, and clinic type, telemedicine visits consistently outperformed in-person visits over time regarding access and care provider concern (P<.001). There were no significant changes over time in satisfaction with telemedicine visits regarding access, care provider concern, telemedicine technology, or overall assessment (P>.05). CONCLUSIONS: In this study, a large oncology dataset showed that telemedicine resulted in better patient experience of care in terms of access and care provider concern compared with in-person visits. Patient experience of care with telemedicine visits did not change over time, suggesting that implementing telemedicine was effective.

Rapid adaptation of cancer screening practices during COVID-19: A multi-state qualitative study.

Context: The COVID-19 pandemic required primary care practices to rapidly adapt cancer screening procedures to comply with changing guidelines and policies. Objective: This study sought to: 1) identify cancer screening barriers and facilitators during the COVID-19 pandemic; 2) describe cancer screening adaptations; and 3) provide recommendations. Study design: A qualitative study was conducted (n= 42) with primary care staff. Individual interviews were conducted through videoconference from August 2020 - April 2021 and recorded, transcribed, and analyzed for themes using NVivo 12 Plus. Setting: Primary care practices included federally qualified health centers, tribal health centers, rural health clinics, hospital/health system-owned, and academic medical centers located across ten states including urban (55%) and rural (45%) sites. Population studied: Primary care staff included physicians (n=13), residents (n=10), advanced practice providers (n=9), and administrators (n=10). Outcome measures: The interviews assessed perceptions about cancer screening barriers and facilitators, necessary adaptations, and future recommendations. Results: Barriers to cancer screening included delays in primary and specialty care, staff shortages, lack of personal protective equipment, patient hesitancy to receive in-person care, postal service delays for mail-home testing, COVID-19 travel restrictions (for Mexico-US border-crossing patients) and organizational policies (e.g., required COVID-19 testing prior to screening). Facilitators included better care coordination and collaboration due to the pandemic and more time during telehealth visits to discuss cancer screening compared to in-person visits. Adaptations included delayed screening, patient triage (e.g., prioritizing patients overdue for screening), telehealth visits to discuss cancer screening, mail-home testing, coordinating cancer screenings (e.g., providing fecal immunochemical test materials during cervical cancer screening) and same-day cancer screening. Recommendations included more public health education about the importance of cancer screening during COVID-19, more mail-home testing, and expanded healthcare access (e.g., weekend clinic) to address patient backlogs for cancer screening. Conclusions: Primary care staff developed innovative strategies to adapt cancer screening during the COVID-19 pandemic. Unresolved challenges (e.g., patient backlogs) will require additional implementation stra.

Patient and caregiver experience with telehealth for surgical cancer care: A qualitative study.

INTRODUCTION: The COVID-19 pandemic led to telemedicine adoption for many medical specialties, including surgical cancer care. To date, the evidence for patient experience of telemedicine among patients with cancer undergoing surgery is limited to quantitative surveys. Thus, this study qualitatively assessed the patient and caregiver experience of telehealth visits for surgical cancer care. METHODS: We conducted semistructured interviews with 25 patients with cancer and three caregivers who had completed a telehealth visit for preanesthesia or postoperative visits. Interviews covered visit descriptions, overall satisfaction, system experience, visit quality, what roles caregivers had, and thoughts on what types of surgery-related visits would be appropriate through telehealth versus in-person. RESULTS: Telehealth delivery for surgical cancer care was generally viewed positively. Multiple factors influenced the patient experience, including prior experience with telemedicine, ease of scheduling visits, smooth connection experiences, having access to technical support, high communication quality, and visit thoroughness. Participants identified use cases on telehealth for surgical cancer care, including postoperative visits for uncomplicated surgical procedures and educational visits. CONCLUSIONS: Patient experiences with telehealth for surgical care are influenced by smooth system experiences, high-quality patient-clinician communications, and a patient-centered focus. Interventions are needed to optimize telehealth delivery (e.g., improve telemedicine platform usability).

Evaluation of Employment Loss and Financial Hardship Among US Adults With Disabilities During the COVID-19 Pandemic.

This cross-sectional study estimates the prevalence and determinants of employment loss and financial hardship among adults with disabilities during the COVID-19 pandemic.

People With Functional Disability and Access to Health Care During the COVID-19 PandemicThe COVID-19 Pandemic: A US Population-based Study.

INTRODUCTION: The COVID-19 pandemic and nationwide restriction measures have disrupted health care delivery and access for the general population. There is limited evidence about access to care issues (delayed and forgone care) due to the pandemic among people with disability (PWD). METHODS: This study used the 2020 National Health Interview Survey data. Disability status was defined by disability severity (moderate and severe disability), type, and the number of disabling limitations. Descriptive analysis and multivariate logistic regression (adjusted for sociodemographic and health-related characteristics) were conducted to estimate delayed/forgone care (yes/no) between PWD and people without disability (PWoD). RESULTS: Among 17,528 US adults, 40.7% reported living with disability. A higher proportion of respondents with severe and moderate disability reported delaying care than PWoD (severe=33.2%; moderate=27.5%; PWoD=20.0%, P<0.001). The same was true for forgone medical care (severe=26.6%; moderate=19.0%; PWoD=12.2%, P<0.001). Respondents with a moderate disability {delayed [odds ratio (OR)=1.33, 95% confidence interval (CI)=1.19, 1.49]; forgone [OR=1.46, 95% CI=1.28, 1.67]} and a severe disability [delayed (OR=1.52, 95% CI=1.27, 1.83); forgone (OR=1.84, 95% CI=1.49, 2.27)] were more likely to report delayed medical care and forgone medical care compared with PWoD. These findings were consistent across the models using disability type and the number of limitations. CONCLUSIONS: PWD were more likely to experience COVID-19-related delays in or forgone medical care compared with PWoD. The more severe and higher frequency of disabling limitations were associated with higher degrees of delayed and forgone medical care. Policymakers need to develop disability-inclusive responses to public health emergencies and postpandemic care provision among PWD.

Estimated Indirect Cost Savings of Using Telehealth Among Nonelderly Patients With Cancer.

Importance: Patients with cancer typically have greater financial hardships and time costs than individuals without cancer. The COVID-19 pandemic has exacerbated this, while posing substantial challenges to delivering cancer care and resulting in important changes in care-delivery models, including the rapid adoption of telehealth. Objective: To estimate patient travel, time, and cost savings associated with telehealth for cancer care delivery. Design, Setting, and Participants: An economic evaluation of cost savings from completed telehealth visits from April 1, 2020, to June 30, 2021, in a single-institution National Cancer Institute-Designated Comprehensive Cancer Center. All patients aged 18 to 65 years who completed telehealth visits within the designated time frame and had a Florida mailing address documented in their electronic medical record were included in the study cohort. Data were analyzed from April 2020 to June 2021. Main Outcomes and Measures: The main outcome was estimated patient cost savings from telehealth, which included 2 components: costs of travel (defined as roundtrip distance saved from car travel) and potential loss of productivity due to the medical visit (defined as loss of income from roundtrip travel plus loss of income from in-person clinic visits). Two different models with a combination of 2 different mileage rates ($0.56 and $0.82 per mile) and census tract-level median hourly wages were used. Results: The study included 25 496 telehealth visits with 11 688 patients. There were 4525 (3795 patients) new or established visits and 20 971 (10 049 patients) follow-up visits. Median (IQR) age was 55.0 (46.0-61.0) years among the telehealth visits, with 15 663 visits (61.4%) by women and 18 360 visits (72.0%) by Hispanic non-White patients. According to cost models, the estimated mean (SD) total cost savings ranged from $147.4 ($120.1) at $0.56/mile to $186.1 ($156.9) at $0.82/mile. For new or established visits, the mean (SD) total cost savings per visit ranged from $176.6 ($136.3) at $0.56/mile to $222.8 ($177.4) at $0.82/mile, and for follow-up visits, the mean (SD) total cost savings per visit was $141.1 ($115.3) at $0.56/mile to $178.1 ($150.9) at $0.82/mile. Conclusions and Relevance: In this economic evaluation, telehealth was associated with savings in patients time and travel costs, which may reduce the financial toxicity of cancer care. Expansion of telehealth oncology services may be an effective strategy to reduce the financial burden among patients with cancer.

Self-Reported Unmet Healthcare Needs Due to the COVID-19 Pandemic and Emergency Services Use and Hospitalization Among Cancer Survivors.

Introduction: The COVID-19 pandemic has significantly disrupted the entire healthcare system, resulting in unmet needs for medical care (e.g., delayed or forgone care) among patients with cancer. Methods: Using 2020 National Health Interview Survey data, we examined the prevalence of unmet healthcare needs and whether the self-reported experience of having delayed or forgone healthcare is associated with increased emergency services use and hospitalizations. A multivariable logistic regression model was used to assess the associations between unmet healthcare needs because of COVID-19 and emergency services use and hospitalization, controlling for potential confounding. All analysis was conducted in March and April 2022. Results: Among 2,386 study participants living with cancer (representing 25.6 million U.S. adults), 33.7% reported having unmet healthcare needs because of the COVID-19 pandemic. The prevalence of unmet healthcare needs was higher among younger cancer survivors and those with higher education. In the adjusted analysis, cancer survivors with unmet healthcare needs were 31% more likely to report any emergency services use (adjusted OR=1.31, 95% CI=1.05, 1.65) than those without. Having unmet healthcare needs was not significantly associated with hospitalization (p=0.465). Conclusions: Our findings highlight the unmet need for cancer care because of the pandemic and potential adverse health outcomes.

Association of dual COVID-19 and seasonal influenza vaccination with COVID-19 infection and disease severity.

The clinical guideline states that COVID-19 vaccination can be administered concurrently with Influenza (flu) vaccination (dual vaccination). Using data from the 2021 National Health Interview Survey, we conducted descriptive analysis and multivariate logistic regressions to examine the association between dual vaccination status and self-reported COVID-19 infection and severity. Among 21,387 (weighted 185,251,310) U.S. adults, about 22% did not receive either the flu or COVID-19 vaccine, 6.0% received the flu vaccine only, 29.1% received the COVID-19 vaccine only, and 42.5% received both vaccines. In the multivariate analysis, individuals with dual vaccination (OR, 0.65, 95% CI, 0.56-0.75) and COVID-19 vaccine only (OR, 0.71, 95% CI, 0.61-0.82) were significantly less likely to report COVID-19 infection when compared with those unvaccinated. There was no significant difference in self-reported COVID-19 symptom severity by vaccination status. The results suggest that dual vaccination may be an effective strategy to reduce the contagious respiratory disease burden.

Public knowledge and information sources for clinical trials among adults in the USA: evidence from a Health Information National Trends Survey in 2020.

BACKGROUND: Lack of clinical trial awareness has been identified as a barrier to clinical trial recruitment. Identifying factors associated with clinical trial knowledge could inform ongoing efforts to improve diversity in clinical trials. METHODS: Using data from the Health Information National Trends Survey, 2020, we examined the knowledge of clinical trials, associated characteristics, sources of clinical trial information and motives to participate in clinical trials among the general population in the USA. RESULTS: Of 3,772 US adults, 41.3% reported not knowing about clinical trials. Prevalence of having no knowledge of clinical trials was higher among Hispanic adults (51.8%) and non-Hispanic Black adults (41.8%) compared with non-Hispanic White adults (37.4%; p=0.013). Other significant predictors of knowledge about clinical trials included higher education, online health information-seeking behaviour and patient portal access. Most respondents (73.2%) reported that healthcare providers were the most trusted source of information. Helping other people (71.6%) was the primary motivation for clinical trial participation, followed by financial compensation (12.5%) and receiving better treatment (5.1%). CONCLUSION: There is a gap in knowledge about clinical trials among the US population. Development of multimodal approaches, including online and offline information broadcasting, is needed to improve knowledge and clinical trial recruitment in diverse populations.

Association Between Bariatric Surgery and Severe COVID-19 Outcomes in Florida.

Less is known whether bariatric surgery (BS) is associated with improved outcomes of COVID-19 complications among patients with class III obesity. Using data from the Florida's state inpatient database (SID) in 2020, we performed multivariable logistic regressions to investigate the impact of prior BS on three separate events, including admission due to COVID-19 among patients eligible for BS (non-BS) and those with prior BS, ventilator usage, and all-cause mortality among those admitted due to COVID-19. Of 409,665 patients included in this study, 25,116 (6.1%) had a history of BS. Results from adjusted logistic regression showed that prior BS was associated with decreased risk of admission due to COVID-19 than that in non-BS group. The risk reduction was smaller among those with class III obesity (adjusted odds ratio [aOR]: 0.58; 95% CI: 0.51-0.66; p < 0.001) than those without (aOR: 0.32; 95% CI: 0.28-0.38; p < 0.001). Compared with the non-BS group, aOR of ventilator use and all-cause mortality for patients without class III obesity decreased by 58% and 78% (p < 0.05), respectively. However, these significances disappeared among patients with continued class III obesity after BS. Our findings suggest that patients with continued class III obesity after BS were still at higher risk of severe COVID-19 outcomes than those without.

COVID-19 Vaccination Rates Among US Adults With Vision or Hearing Disabilities.

Importance: Despite persistent care delivery inequities, limited studies have assessed COVID-19 vaccination rates among adults with vision or hearing disabilities. Objective: To estimate the prevalence of and factors in COVID-19 vaccination among US adults with vision or hearing disabilities. Design, Setting, and Participants: This cross-sectional study assessed data from adults who participated in the US Census Bureau Household Pulse Survey from April 2021 through March 2022. The survey assessed COVID-19 vaccine initiation, vaccine series completion, and determinants of health care access, including demographic characteristics, clinical characteristics, and social determinants of health. Exposures: Vision disability (serious difficulty seeing even with eyeglasses or blindness) and hearing disability (serious difficulty hearing even with a hearing aid or deafness). Main Outcomes and Measures: First dose of COVID-19 vaccine. Adjusted estimated probabilities and 95% CIs of COVID-19 vaccine initiation were calculated using multivariable logistic regression adjusted for survey week, demographic characteristics, clinical characteristics, and social determinants of health. Results: In this study of 916 085 US adults (weighted population, 192 719 992; mean [SD] age, 54.0 [15.9] years; 52.0% women), most participants had initiated the COVID-19 vaccine series (82.7%). Adults with serious difficulty seeing (mean difference, -6.3%; 95% CI, -7.5% to -5.1%; P < .001) and blindness (mean difference, -20.1%; 95% CI, -25.1% to -15.0%; P < .001) had lower vaccination rates compared with adults with little to no vision impairment. Adults with serious difficulty hearing (mean difference, -2.1%; 95% CI, -3.5% to -0.7%; P = .003) and deafness (mean difference, -17.7%; 95% CI, -21.8% to -13.6%; P < .001) were less likely to initiate the COVID-19 vaccine compared with adults with little to no hearing impairment. Controlling for other factors, adults with blindness (mean difference, -6.3%; 95% CI, -11.1% to -1.5%; P = .009) were less likely to initiate the COVID-19 vaccine compared with adults with little to no vision impairment. Controlling for other factors, adults with deafness (mean difference, -5.5%; 95% CI, -9.2% to -1.9%; P = .003) were less likely to initiate the COVID-19 vaccine compared with adults with little to no hearing impairment. Conclusion and Relevance: The findings of this cross-sectional study suggest that COVID-19 vaccine initiation is lower among adults with vision or hearing disabilities compared with adults without disabilities; this information may inform initiatives to promote equitable and accessible vaccination. Additional research may be needed to monitor COVID-19 vaccination disparities among adults with vision or hearing disabilities and to address disparities.

Cancer Screening Among Rural and Urban Clinics During COVID-19: A Multistate Qualitative Study.

PURPOSE: The effects of COVID-19 have been understudied in rural areas. This study sought to (1) identify cancer screening barriers and facilitators during the pandemic in rural and urban primary care practices, (2) describe implementation strategies to support cancer screening, and (3) provide recommendations. METHODS: A qualitative study was conducted (N = 42) with primary care staff across 20 sites. Individual interviews were conducted through videoconference from August 2020 to April 2021 and recorded, transcribed, and analyzed using deductive and inductive coding (hybrid approach) in NVivo 12 Plus. Practices included federally qualified health centers, tribal health centers, rural health clinics, hospital/health system-owned clinics, and academic medical centers across 10 states including urban (55%) and rural (45%) sites. Staff included individuals serving in the dual role of health care provider and administrator (21.4%), health care administrator (23.8%), physician (19.0%), advanced practice provider (11.9%), or resident (23.8%). The interviews assessed perceptions about cancer screening barriers and facilitators, implementation strategies, and future recommendations. RESULTS: Participants reported multilevel barriers to cancer screening including policy-level (eg, elective procedure delays), organizational (eg, backlogs), and individual (eg, patient cancellation). Several facilitators to screening were noted, such as home-based testing, using telehealth, and strong partnerships with referral sites. Practices used strategies to encourage screening, such as incentivizing patients and providers and expanding outreach. Rural clinics reported challenges with backlogs, staffing, telehealth implementation, and patient outreach. CONCLUSION: Primary care staff used innovative strategies during the pandemic to promote cancer screening. Unresolved challenges (eg, backlogs and inability to implement telehealth) disproportionately affected rural clinics.

Health Care Providers' and Professionals' Experiences With Telehealth Oncology Implementation During the COVID-19 Pandemic: A Qualitative Study.

BACKGROUND: Rapid implementation of telehealth for cancer care during COVID-19 required innovative and adaptive solutions among oncology health care providers and professionals (HPPs). OBJECTIVE: The aim of this qualitative study was to explore oncology HPPs' experiences with telehealth implementation during the COVID-19 pandemic. METHODS: This study was conducted at Moffitt Cancer Center (Moffitt), an NCI (National Cancer Institute)-Designated Comprehensive Cancer Center. Prior to COVID-19, Moffitt piloted telehealth visits on a limited basis. After COVID-19, Moffitt rapidly expanded telehealth visits. Telehealth visits included real-time videoconferencing between HPPs and patients and virtual check-ins (ie, brief communication with an HPP by telephone only). We conducted semistructured interviews with 40 oncology HPPs who implemented telehealth during COVID-19. The interviews were recorded, transcribed verbatim, and analyzed for themes using Dedoose software (version 4.12). RESULTS: Approximately half of the 40 participants were physicians (n=22, 55%), and one-quarter of the participants were advanced practice providers (n=10, 25%). Other participants included social workers (n=3, 8%), psychologists (n=2, 5%), dieticians (n=2, 5%), and a pharmacist (n=1, 3%). Five key themes were identified: (1) establishing and maintaining patient-HPP relationships, (2) coordinating care with other HPPs and informal caregivers, (3) adapting in-person assessments for telehealth, (4) developing workflows and allocating resources, and (5) future recommendations. Participants described innovative strategies for implementing telehealth, such as coordinating interdisciplinary visits with multiple HPPs and inviting informal caregivers (eg, spouse) to participate in telehealth visits. Health care workers discussed key challenges, such as workflow integration, lack of physical exam and biometric data, and overcoming the digital divide (eg, telehealth accessibility among patients with communication-related disabilities). Participants recommended policy advocacy to support telehealth (eg, medical licensure policies) and monitoring how telehealth affects patient outcomes and health care delivery. CONCLUSIONS: To support telehealth growth, implementation strategies are needed to ensure that HPPs and patients have the tools necessary to effectively engage in telehealth. At the same time, cancer care organizations will need to engage in advocacy to ensure that policies are supportive of oncology telehealth and develop systems to monitor the impact of telehealth on patient outcomes, health care quality, costs, and equity.

Acceptability of Research and Health Care Visits During the COVID-19 Pandemic: Cross-sectional Survey Study.

BACKGROUND: The COVID-19 pandemic has had a widespread impact on attendance in biomedical research and health care visits. OBJECTIVE: This study aimed to identify when and how American adults might feel comfortable about resuming in-person research and health care visits. METHODS: Cross-sectional questionnaire data were collected from 135 adults (age: median 48 years; women: n=113, 83.7%; White participants: n=92, 68.2%) who were engaged in health-related research. RESULTS: More than half of the respondents (65/122, 53.3%) felt that the COVID-19 pandemic positively affected their desire to participate in research. Although 73.6% (95/129) of respondents also indicated a willingness to attend in-person health care visits while Centers for Disease Control and Prevention (CDC) guidelines are implemented, 85.8% (109/127) indicated a willingness to attend in-person, outdoor visits, and 92.2% (118/128) reported a willingness to attend drive-through visits (with CDC guidelines implemented during both visit types). Videoconferencing was the most preferred format for intervention visits; however, adults over the age of 65 years preferred this format less than younger adults (P=.001). CONCLUSIONS: Researchers and clinicians should continue to provide opportunities for continuing the conduction of remote-based interventions while enforcing CDC guidelines during in-person visits.

Tele-ICUs for COVID-19: A Look at National Prevalence and Characteristics of Hospitals Providing Teleintensive Care.

PURPOSE: Amidst the COVID-19 outbreak, the use of intensive care unit telemedicine (tele-ICUs) may be one mechanism to provide patient care, particularly in rural parts of the United States. The purpose of this research was to inform hospital decision makers considering tele-ICUs, policy makers weighing immediate and longer-term funding and reimbursement decisions relative to tele-ICU care, and researchers conducting future work evaluating tele-ICUs. METHODS: We compared hospitals that reported providing teleintensive care to hospitals that reported not providing teleintensive care in the 2018 American Hospital Association Annual Survey (AHAAS). Differences between groups were tested using Pearson's chi-square (categorical variables) and t-tests (continuous variables) using 0.05 as the probability of Type 1 error. The study sample included all US short-term, acute care hospitals that responded to the AHAAS in 2018. Our key variable of interest was whether a hospital reported having any tele-ICU capabilities in the 2018 AHAAS. Other factors evaluated were ownership, region, beds, ICU beds, outpatient visits, emergency department visits, full-time employees, and whether a hospital was rural, a critical access hospital, a major teaching hospital, or part of a health system. FINDINGS: Larger, not-for-profit, nonrural, noncritical access, teaching hospitals that were part of a health system, particularly in the Midwest, were more likely to have tele-ICUs. Over one-third of hospital referral regions (HRRs) had zero hospitals with tele-ICUs, 4 had all hospitals with tele-ICU, and the median percent of hospitals with tele-ICU by HRR, weighted by outpatient visits, was 11.3%. CONCLUSIONS AND IMPLICATIONS: We found wide variation in the prevalence of tele-ICUs across HRRs and states. Future work should continue the evaluation of tele-ICU effectiveness and, if favorable, explore the variation we identified for improved access to teleintensive care.

COVID-19 Impacts Mental Health Outcomes and Ability/Desire to Participate in Research Among Current Research Participants.

OBJECTIVE: This study aimed to examine the impact of coronavirus disease 2019 (COVID-19) on current research participants' mental health outcomes, ability to adhere to behavioral intervention recommendations, and desire to participate in research. METHODS: A quantitative/qualitative cross-sectional survey was used among adults currently enrolled in health-related research (N = 250; 85% women; > 50% currently enrolled in behavioral weight loss intervention). RESULTS: COVID-19 was perceived as a severe threat by most (62.3%). Related to COVID-19, 29.6% of participants reported moderate/severe symptoms of anxiety/depression, and 68.4% reported moderate/severe posttraumatic stress disorder (PTSD) symptomatology, with women more likely to demonstrate moderate/severe anxiety/depression (P = 0.047) and PTSD symptomatology (P = 0.028) relative to men. Those with moderate/severe levels of anxiety/depression (P = 0.0154) and distress (P = 0.0330) were more likely to report a decreased desire to participate in research. Among those in behavioral interventions, individuals perceiving COVID-19 as a moderate/severe threat or experiencing moderate/severe depression or PTSD symptomatology were 4 to 19 times more likely to report that COVID-19 affected their ability to adhere to behavioral recommendations. Qualitative analysis identified four themes describing COVID-19's impact on research experiences: transition, remote intervention delivery, ability to adhere to program goals, and research participation interest. CONCLUSIONS: These data suggest that participants engaged in health-related research perceive COVID-19 as a significant threat, affecting mental health, desire to participate in research, and ability to adhere to intervention recommendations.

Population-Level Interest and Telehealth Capacity of US Hospitals in Response to COVID-19: Cross-Sectional Analysis of Google Search and National Hospital Survey Data.

BACKGROUND: As the novel coronavirus disease (COVID-19) is widely spreading across the United States, there is a concern about the overloading of the nation's health care capacity. The expansion of telehealth services is expected to deliver timely care for the initial screening of symptomatic patients while minimizing exposure in health care facilities, to protect health care providers and other patients. However, it is currently unknown whether US hospitals have the telehealth capacity to meet the increasing demand and needs of patients during this pandemic. OBJECTIVE: We investigated the population-level internet search volume for telehealth (as a proxy of population interest and demand) with the number of new COVID-19 cases and the proportion of hospitals that adopted a telehealth system in all US states. METHODS: We used internet search volume data from Google Trends to measure population-level interest in telehealth and telemedicine between January 21, 2020 (when the first COVID-19 case was reported), and March 18, 2020. Data on COVID-19 cases in the United States were obtained from the Johns Hopkins Coronavirus Resources Center. We also used data from the 2018 American Hospital Association Annual Survey to estimate the proportion of hospitals that adopted telehealth (including telemedicine and electronic visits) and those with the capability of telemedicine intensive care unit (tele-ICU). Pearson correlation was used to examine the relations of population search volume for telehealth and telemedicine (composite score) with the cumulative numbers of COVID-19 cases in the United States during the study period and the proportion of hospitals with telehealth and tele-ICU capabilities. RESULTS: We found that US population-level interest in telehealth increased as the number of COVID-19 cases increased, with a strong correlation (r=0.948, P<.001). We observed a higher population-level interest in telehealth in the Northeast and West census region, whereas the proportion of hospitals that adopted telehealth was higher in the Midwest region. There was no significant association between population interest and the proportion of hospitals that adopted telehealth (r=0.055, P=.70) nor hospitals having tele-ICU capability (r=-0.073, P=.61). CONCLUSIONS: As the number of COVID-19 cases increases, so does the US population's interest in telehealth. However, the level of population interest did not correlate with the proportion of hospitals providing telehealth services in the United States, suggesting that increased population demand may not be met with the current telehealth capacity. Telecommunication infrastructures in US hospitals may lack the capability to address the ongoing health care needs of patients with other health conditions. More practical investment is needed to deploy the telehealth system rapidly against the impending patient surge.