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1.
J Public Health (Oxf) ; 2022 Oct 04.
Article in English | MEDLINE | ID: covidwho-2051532

ABSTRACT

BACKGROUND: In this longitudinal cohort study, we examined the socio-demographic and psychological predictors of alcohol use initiation during the COVID-19 pandemic in a sample of never alcohol users aged ≥21 prior to COVID-19. METHODS: Our study population consisted of 56 930 patients aged ≥21, as of 30 March 2019 were collected from a pre-COVID period of 1 year before 31 March 2020, and during-COVID, a period between 1 April 2020 and 30 March 2021. Univariable and multivariable logistic regression models were utilized to examine the roles of socio-demographic variables (gender, age, education, Area Deprivation Index and rural residence) changes in anxiety and depression severity as predictors of alcohol use initiation. RESULTS: Age, gender, race, ethnicity, education and rural status were significant predictors in multivariable analysis. A subgroup analysis showed neither anxiety nor depression had a significant association with alcohol use initiation. CONCLUSION: Women, younger individuals, those living in a rural area and people who smoke cigarettes were more likely to initiate alcohol use during the pandemic. Our study has public health and clinical implications such as the need for targeted alcohol use screening and intervention for vulnerable individuals.

2.
Telehealth and Medicine Today ; 7(1), 2022.
Article in English | ProQuest Central | ID: covidwho-2026489

ABSTRACT

Importance: This very large claims data analysis documents widespread adoption of telehealth use by patients with diabetes during the first year of the COVID-19 pandemic, giving us insight into the potential role of telehealth as we enter a stage of “new normal” of healthcare delivery in the U.S. Objective: The COVID-19 Telehealth Impact Study was designed to describe the natural experiment of telehealth adoption during the pandemic. This focused analysis can assist program development for care of large populations of patients with diabetes. Design, Setting, Participants: In March 2020, the MITRE Corporation and Mayo Clinic founded the COVID-19 Healthcare Coalition (C19HCC) and Telehealth Impact Study to respond to the pandemic. We report trends using a data set of over 2 billion healthcare claims covering over 50% of private insurance activity in the U.S. (January 2019-March 2021). Main Outcomes and Measures: We compared rates of telehealth use in the one-year pre and one-year post onset of the COVID-19 pandemic among a population of 8,339,633 patients with diabetes. Results: Compared to a baseline of very low telehealth use in 2019, there was rapid adoption of telehealth by patients with diabetes in Spring 2020. 27% of diabetics used telehealth in Q2 2020 and use rates declined in the ensuing months to approximately 13%. Diabetics and their providers used telehealth to address a wide variety of health problems. 77% of telehealth visits addressed diabetes, 53% hypertension and over 40% of visits addressed mental and behavioral health diagnoses. Audio-only (telephone visits) accounted for a substantial portion of telehealth encounters (10.0- 16.3%) and will be an important consideration for future telehealth planning. Over the course of the first 12 months of the pandemic, 98% diabetics who used telehealth used 4 or fewer telehealth visit. Conclusions and Relevance: We believe that telehealth will quickly become a best practice for routine care of patients with diabetes and other chronic conditions. Telehealth interactions 2-4 times per year supplemented with remote monitoring for glucose, blood pressure and weight have the potential to greatly enhance patient care. Further research will be needed to measure the telehealth impact on glycemic control, patient satisfaction and other outcomes. We encourage CMS and other payers to embrace and promote use of telehealth based on this real-world experience of patients and providers during the pandemic.

3.
Telehealth and Medicine Today ; 6(3), 2021.
Article in English | ProQuest Central | ID: covidwho-2026480

ABSTRACT

Importance: This three-part study characterizes the widespread implementation of telehealth during the first year of the COVID-19 pandemic, giving us insight into the role of telehealth as we enter a stage of “new normal” healthcare delivery in the U.S. Objective: The COVID-19 Telehealth Impact Study was designed to describe the natural experiment of telehealth adoption during the pandemic. Using a large claims data stream and surveys of providers and patients, we studied telehealth in all 50 states to inform healthcare leaders. Design, Setting, Participants: In March 2020, the MITRE Corporation and Mayo Clinic founded the COVID-19 Healthcare Coalition (C19HCC), to respond to the pandemic. We report trends using a dataset of over 2 billion healthcare claims covering over 50% of private insurance activity in the U.S. (January 2019-December 2020), along with key elements from our provider survey (July-August 2020) and patient survey (November 2020 - February 2021). Main Outcomes and Measures: There was rapid and widespread adoption of telehealth in Spring 2020 with over 12 million telehealth claims in April 2020, accounting for 49.4% of total health care claims. Providers and patients expressed high levels of satisfaction with telehealth. 75% of providers indicated that telehealth enabled them to provide quality care. 84% of patients agreed that quality of their telehealth visit was good. Results: Peak levels of telehealth use varied widely among states ranging from 74.9% in Massachusetts to 25.4% in Mississippi. Every clinical discipline saw a steep rise with the largest claims volume in behavioral health. Provision of care by out-of-state provider was common at 6.5% (October-December 2020). Providers reported multiple modalities of telehealth care delivery. 74% of patients indicated they will use telehealth services in the future. Conclusions and Relevance: Innovation shown by providers and patients during this period of rapid telehealth expansion constitutes a great natural experiment in care delivery with evidence supporting widespread clinical adoption and satisfaction on the part of both patients and clinicians. The authors encourage continued broad access to telehealth over the next 12 months to allow telehealth best practices to emerge, creating a more effective and resilient system of care delivery.

4.
Mayo Clinic Proceedings ; 2022.
Article in English | ScienceDirect | ID: covidwho-2007936

ABSTRACT

Objective To evaluate care utilization, cost, and mortality among high-risk patients enrolled in a COVID-19 Remote Patient Monitoring (RPM) program. Methods This retrospective analysis included patients diagnosed with COVID-19 at risk for severe disease who enrolled in the RPM program between March 2020 - October 2021. The program included in-home technology for symptom and physiologic data monitoring with centralized care management. Propensity score matching established matched cohorts of RPM-engaged (defined as ≥1 RPM technology interactions) and non-engaged patients using a logistic regression model of 59 baseline characteristics. Billing codes and the electronic death certificate system were utilized for data ion from the EHR and reporting of care utilization and mortality endpoints. Results Among 5,796 RPM-enrolled patients, 80.0% engaged with the technology. Following matching, 1,128 pairs of RPM engaged and non-engaged patients comprised the analysis cohorts. Mean patient age was 63.3 years, 50.9% of patients were female sex, and 81.9% were non-Hispanic, white. RPM-engaged patients experienced significantly lower rates of 30-day, all-cause hospitalization (13.7% vs 18.0%, P=.01), prolonged hospitalization (3.5% vs 6.7%, P=.001), ICU admission (2.3% vs. 4.2%, P=.01), and mortality [0.5% vs. 1.7%, OR 0.31 (0.12, 0.78), P=.01], as well as cost of care ($2,306.33 USD vs $3,565.97 USD, P=0.04), than those enrolled in RPM but non-engaged. Conclusions High-risk, COVID-19 patients enrolled and engaged in an RPM program experienced lower rates of hospitalization, ICU admission, mortality, and cost than those enrolled and non-engaged. These findings translate to improved hospital bed access and patient outcomes.

5.
Sleep ; 45(Suppl 1):A166-A167, 2022.
Article in English | EuropePMC | ID: covidwho-1998894

ABSTRACT

Introduction The COVID-19 pandemic accelerated use of telehealth, an expansion of services that required the appropriate technological infrastructure for health care facilities and in patient homes. Telehealth on the one hand has held promise for addressing health disparities perpetuated by inadequate rural access, but delivery requires extensive broadband and technologic access. That creates the possibility for new kinds of healthcare disparities. In addition, COVID-19 forced marked reduction in in-lab polysomnography (PSG), and concurrent expansion of home sleep apnea testing (HSAT). We hypothesized that the pandemic led to an increase in the overall frequency of telehealth and HSAT utilization, particularly in those who were younger, White, more educated, and from a non-local area. Methods We completed a retrospective chart review of all adult patients seen by all provider types across the Sleep Medicine practices in Mayo Clinic Rochester, Arizona, Florida, and the Mayo Clinic Health System between 1) 6/1/18—3/8/20 (Pre-COVID-19), 2) 3/9/20—4/19/20 (Early COVID-19), and 3) 4/20/20—present (Late COVID-19). We recorded the total number of PSGs and HSATs and total number of face-to-face and telehealth visits, along with the age, gender, race, educational level, and locality by zip code for patients served. These data were compared across the 3 timeframes. Results Average monthly visits changed from Pre-COVID-19, Early COVID-19, to Late COVID-19 [2194.7/m, 1416.5/m, 2690.6/m (P<0.001)]. Average monthly sleep test volumes also changed [1004.1/m, 530.5/m, 1123.4/m (P<0.001)], with a proportionate increase in HSATs across the 3 periods [34.71%, 65.37%, 53.59% (P<0.005)]. The increase in Late COVID-19 in telehealth visits occurred proportionately more in those who were younger, female, non-White, college and post-graduate educated, and from a non-local area. The increase in use of HSATs occurred proportionately more in patients who were younger, female, non-White, college and post-graduate educated, and from a local area. Conclusion The COVID-19 pandemic increased the use of telehealth visits and HSATs in Sleep Medicine practices across our enterprise, particularly in those who are younger and more educated, which may be due to ease of use with and access to technology. The reasons for the presence of additional disparities based upon gender, race, and locality needs further exploration. Support (If Any)  

6.
JMIR Formative Research ; 6(5), 2022.
Article in English | ProQuest Central | ID: covidwho-1871737

ABSTRACT

Background: During the COVID-19 pandemic, to prevent the spread of the virus, federal regulatory barriers around telemedicine were lifted, and health care institutions encouraged patients to use telemedicine, including video appointments. Many patients, however, still chose face-2-face (f2f) appointments for nonemergent clinical care. Objective: We explored patients’ personal and environmental barriers to the use of video appointments from April 2020 to December 2020. Methods: We conducted qualitative telephone interviews of Mayo Clinic patients who attended f2f appointments at the Mayo Clinic from April 2020 to December 2020 but did not utilize Mayo Clinic video appointment services during that time frame. Results: We found that, although most patients were concerned about preventing COVID-19 transmission, they trusted Mayo Clinic to keep them safe when attending f2f appointments. Many expressed that a video appointment made it difficult to establish rapport with their providers. Other common barriers to video appointments were perceived therapeutic benefits of f2f appointments, low digital literacy, and concerns about privacy and security. Conclusions: Our study provides an in-depth investigation into barriers to engaging in video appointments for nonemergent clinical care in the context of the COVID-19 pandemic. Our findings corroborate many barriers prevalent in the prepandemic literature and suggest that rapport barriers need to be analyzed and problem-solved at a granular level.

7.
NPJ Digit Med ; 4(1): 123, 2021 Aug 13.
Article in English | MEDLINE | ID: covidwho-1356587

ABSTRACT

Established technology, operational infrastructure, and nursing resources were leveraged to develop a remote patient monitoring (RPM) program for ambulatory management of patients with COVID-19. The program included two care-delivery models with different monitoring capabilities supporting variable levels of patient risk for severe illness. The primary objective of this study was to determine the feasibility and safety of a multisite RPM program for management of acute COVID-19 illness. We report an evaluation of 7074 patients served by the program across 41 US states. Among all patients, the RPM technology engagement rate was 78.9%. Rates of emergency department visit and hospitalization within 30 days of enrollment were 11.4% and 9.4%, respectively, and the 30-day mortality rate was 0.4%. A multisite RPM program for management of acute COVID-19 illness is feasible, safe, and associated with a low mortality rate. Further research and expansion of RPM programs for ambulatory management of other acute illnesses are warranted.

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