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1.
JMIR Form Res ; 6(3): e34088, 2022 Mar 10.
Article in English | MEDLINE | ID: covidwho-1736653

ABSTRACT

BACKGROUND: The COVID-19 pandemic prompted safety-net health care systems to rapidly implement telemedicine services with little prior experience, causing disparities in access to virtual visits. While much attention has been given to patient barriers, less is known regarding system-level factors influencing telephone versus video-visit adoption. As telemedicine remains a preferred service for patients and providers, and reimbursement parity will not continue for audio visits, health systems must evaluate how to support higher-quality video visit access. OBJECTIVE: This study aimed to assess health system-level factors and their impact on telephone and video visit adoption to inform sustainability of telemedicine for ambulatory safety-net sites. METHODS: We conducted a cross-sectional survey among ambulatory care clinicians at a hospital-linked ambulatory clinic network serving a diverse, publicly insured patient population between May 28 and July 14, 2020. We conducted bivariate analyses assessing health care system-level factors associated with (1) high telephone adoption (4 or more visits on average per session); and (2) video visit adoption (at least 1 video visit on average per session). RESULTS: We collected 311 responses from 643 eligible clinicians, yielding a response rate of 48.4%. Clinician respondents (N=311) included 34.7% (n=108) primary or urgent care, 35.1% (n=109) medical, and 7.4% (n=23) surgical specialties. Our sample included 178 (57.2%) high telephone adopters and 81 (26.05%) video adopters. Among high telephone adopters, 72.2% utilized personal devices for telemedicine (vs 59.0% of low telephone adopters, P=.04). Video nonadopters requested more training in technical aspects than adopters (49.6% vs 27.2%, P<.001). Primary or urgent care had the highest proportion of high telephone adoption (84.3%, compared to 50.4% of medical and 37.5% of surgical specialties, P<.001). Medical specialties had the highest proportion of video adoption (39.1%, compared to 14.8% of primary care and 12.5% of surgical specialties, P<.001). CONCLUSIONS: Personal device access and department specialty were major factors associated with high telephone and video visit adoption among safety-net clinicians. Desire for training was associated with lower video visit use. Secure device access, clinician technical trainings, and department-wide assessments are priorities for safety-net systems implementing telemedicine.

2.
BMC Health Serv Res ; 22(1): 195, 2022 Feb 14.
Article in English | MEDLINE | ID: covidwho-1690919

ABSTRACT

BACKGROUND: The COVID-19 pandemic triggered unprecedented expansion of outpatient telemedicine in the United States in all types of health systems, including safety-net health systems. These systems generally serve low-income, racially/ethnically/linguistically diverse patients, many of whom face barriers to digital health access. These patients' perspectives are vital to inform ongoing, equitable implementation efforts. METHODS: Twenty-five semi-structured interviews exploring a theoretical framework of technology acceptability were conducted from March through July 2020. Participants had preferred languages of English, Spanish, or Cantonese and were recruited from three clinics (general medicine, obstetrics, and pulmonary) within the San Francisco Health Network. Both deductive and inductive coding were performed. In a secondary analysis, qualitative data were merged with survey data to relate perspectives to demographic factors and technology access/use. RESULTS: Participants were diverse with respect to language (52% non-English-speaking), age (range 23-71), race/ethnicity (24% Asian, 20% Black, 44% Hispanic/Latinx, 12% White), & smartphone use (80% daily, 20% weekly or less). All but 2 had a recent telemedicine visit (83% telephone). Qualitative results revealed that most participants felt telemedicine visits fulfilled their medical needs, were convenient, and were satisfied with their telemedicine care. However, most still preferred in-person visits, expressing concern that tele-visits relied on patients' abilities to access telemedicine, as well as monitor and manage their own health without in-person physical evaluation. CONCLUSIONS: High satisfaction with telemedicine can co-exist with patient-expressed hesitations surrounding the perceived effectiveness, self-efficacy, and digital access barriers associated with a new model of care. More research is needed to guide how healthcare systems and clinicians make decisions and communicate about visit modalities to support high-quality care that responds to patients' needs and circumstances.


Subject(s)
COVID-19 , Telemedicine , Female , Humans , Pandemics , Patient Satisfaction , Personal Satisfaction , Pregnancy , SARS-CoV-2 , United States
3.
Journal of Health Care for the Poor and Underserved ; 32(2 Supplement):220-240, 2021.
Article in English | ProQuest Central | ID: covidwho-1208000

ABSTRACT

Objective. The COVID-19 pandemic prompted unprecedented expansion of telemedicine services. We sought to describe clinician experiences providing telemedicine to publiclyinsured, lowincome patients during COVID-19. Methods. Online survey of ambulatory clinicians in an urban safetynet hospital system, conducted May 28, 2020–July 14, 2020. Results. Among 311 participants (response rate 48.3%), 34.7% (n=108/311) practiced in primary/urgent care, 37.0% (n=115/311) medical specialty, and 7.7% (n=24/311) surgical clinics. A large majority (87.8%, 273/311) had conducted telephone visits, 26.0% (81/311) video. Participants reported observing both technical and nontechnical patient barriers. Clinicians reported concerns about the diagnostic safety of telephone (58.9%, 129/219) vs. video (35.3%, 24/68). However, clinician comfort with telemedicine was high for telephone (89.3%, 216/242) and for video (91.0%, 61/67), with many clinicians (92.1%, 220/239 telephone;90.9%, 60/66 video) planning to continue telemedicine after COVID-19. Conclusions. Clinicians in a safetynet health care system report great comfort with and intention to continue telemedicine after the pandemic, despite safety concerns and patient challenges.

4.
Obstet Gynecol ; 137(3): 487-492, 2021 03 01.
Article in English | MEDLINE | ID: covidwho-1066431

ABSTRACT

The use of telemedicine in U.S. perinatal care has drastically increased during the coronavirus disease 2019 (COVID-19) pandemic, and will likely continue given the national focus on high-value, patient-centered care. If implemented in an equitable manner, telemedicine has the potential to reduce disparities in care access and related outcomes that stem from systemic racism, implicit biases and other forms of discrimination within our health care system. In this commentary, we address implementation factors that should be considered to ensure that disparities are not widened as telemedicine becomes more integrated into care delivery.


Subject(s)
COVID-19/prevention & control , Delivery of Health Care/standards , Healthcare Disparities , Perinatal Care/methods , Telemedicine/economics , COVID-19/epidemiology , Female , Health Policy , Humans , Patient Acceptance of Health Care , Pregnancy , United States
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