Telemedicine Here to Stay? Key Indicators to Patient Satisfaction

INTRODUCTION AND OBJECTIVE: The COVID-19 pandemic initiated rapid widespread utilization of telemedicine affecting all health care providers, including those in pediatric urology. Understanding the factors of patient and parent satisfaction can aid in health care delivery. The aim of this study was to identify key indicators of patient and parent satisfaction with pediatric urology telemedicine visits. METHOD(S): We conducted a prospective cross-sectional survey of all patients evaluated with a telehealth visit from October 2021 - April 2022. We included all consecutive patients aged 0-18 years who received an outpatient pediatric urology telehealth visit. All patients received an 8-question patient/parent reported outcome (PRO) survey via email within 30 days of the visit, including 5 satisfaction questions regarding various aspects of telemedicine rated on a scale of 1-5. Statistical analysis was performed using Pearson correlation, Mann- Whitney U, and Chi Squared tests, with p<0.05 considered significant. RESULT(S): A total of 1213 patients completed a telehealth visit, of which 83 (7%) completed the PRO survey. Visit type included 40 (48%) post-operative, 29 (35%) follow-up, and 14 (17%) new consults. From the survey responses, 84% reported time savings, 31% reported money savings, 30% avoided time away from work, and 27% of children avoided missing school. No technical issues were experienced in 86% of the visits. Satisfaction with telehealth was highest for the post-operative patient, 4.8/5 after orchiopexy and 4.4/5 after circumcision. Patients saved a median travel distance of 22 miles [IQR: 15-41]. Patients living farther than 22 miles had higher satisfaction scores in terms of simplicity and preference to in-person visits compared to those who lived closer (p=0.019). Patients living in zip codes below the median household income had significantly higher satisfaction scores (p =0.032). Patients with public health insurance had significantly higher overall satisfaction scores compared to those with private health insurance (p=0.022). There was no difference in satisfaction based on parent age or whether the patient was evaluated for a new, follow-up, or post-operative video visit. CONCLUSION(S): Children and their caregivers were satisfied with pediatric urology telehealth visits when seen as a new, follow-up, or post-operative patient. Indicators for satisfaction may include long travel distance to the clinic, lower than median household income zip codes, and public health insurance. Appropriate use of telehealth may provide better access to care and optimize healthcare delivery.

Voluntary private health insurance demand by Portuguese seniors before the COVID-19 pandemic.

AIMS: The Portuguese health system is mainly described as a National Health Service (NHS), but it also has some Bismarckian features. On top of these two layers of health insurance coverage, there is a market for voluntary private health insurance (VPHI). Usually, seniors are not eligible for this type of health insurance and this may serve as a complement or supplement to the NHS. The purpose of this work is to identify the main factors associated with holding a VPHI policy among seniors before the COVID-19 pandemic. MATERIAL AND METHODS: We use data collected by the National Health Survey of 2019/20 and estimate a multivariate logistic regression. RESULTS: The main findings show that VPHI may be bought by seniors as a facilitator to access health care, either specialised or dental care. While oral health is not covered by the NHS, specialist care is only available after referral by a gatekeeper and requires a long waiting time to be scheduled. Results show that people who had an appointment with a dentist or a specialist in the last 12 months are more likely to have a VPHI policy. Additionally, it was found that people benefiting from occupation-based insurance schemes are less likely to buy private health insurance. CONCLUSION: The current Portuguese health system organization based on different layers of health protection raises some issues concerning equity to health care access by seniors.

Private health insurance consumption and public health-care provision in OECD countries: Impact of culture, finance, and the pandemic

In this paper, we investigate private health insurance (PHI) spending in Organization for Economic Co-operation and Development (OECD) economies for the period 2000–2020, with a focus on the impact of financial, cultural, and health-environment factors. PHI consumption is positively associated with financial development and cultural–social–economic factors, such as income, education, individualism, uncertainty avoidance, and long-term orientation, whereas it is negatively associated with public health spending, masculinity, indulgence, and power distance. In addition, factors related to the health environment, such as the COVID-19 pandemic, have a negative influence on PHI consumption in the selected OECD economies owing to losses in income. Our findings can serve as guidance for consumers and recommendations for health insurers and policymakers in designing health insurance policies and programs in developed and developing countries. © 2022 Elsevier Inc.

The Cost of Ignoring Vaccines

This perspectives piece focuses on the detrimental cost of ignoring vaccines and refusing vaccination against COVID-19 in the United States. Much of the existing literature regarding the consequences of the unvaccinated emphasizes the impact to population health;however, few academic articles have explored the burden the unvaccinated pose to various sectors of society. This paper analyzes the impact that the unvaccinated have on healthcare systems, the US economy, and global health. Throughout the COVID-19 pandemic, unvaccinated populations were found to have put significant strain on healthcare systems, depleting medical resources and contributing to high rates of healthcare worker shortages. Furthermore, research suggests that between November and December 2021, over 692,000 preventable hospitalizations occurred in unvaccinated individuals, costing the US economy over $13.8 billion. Lastly, it is proposed that the strong international presence of the US, when coupled with high levels of disease transmissibility in the unvaccinated, provides a significant threat to global health. In conclusion, the unvaccinated have caused impacts far beyond that of population health;they have also posed a burden to healthcare systems, the economy, and global public health. Copyright © 2022, Yale Journal of Biology and Medicine Inc. All rights reserved.

Private Health Insurance Consumption and Public Health-Care Provision in OECD Countries: Impact of Culture, Finance, and the Pandemic

In this paper, we investigate private health insurance (PHI) spending in Organisation for Economic Co-operation and Development (OECD) economies for the period 2000–2020, with a focus on the impact of financial, cultural, and health-environment factors. PHI consumption is positively associated with financial development and cultural–social–economic factors, such as income, education, individualism, uncertainty avoidance, and long-term orientation, whereas it is negatively associated with public health spending, masculinity, indulgence, and power distance. In addition, factors related to the health environment, such as the COVID-19 pandemic, have a negative influence on PHI consumption in the selected OECD economies owing to losses in income. Our findings can serve as guidance for consumers and recommendations for health insurers and policymakers in designing health insurance policies and programs in developed and developing countries.

Social Determinants of Health and Biochemical Alcohol Relapse in Alcohol-Associated Liver Disease

Purpose: Alcohol use after liver transplant is associated with higher rates of graft loss and increased mortality;however, there is limited data regarding the factors that influence biochemically confirmed relapse. We aimed to evaluate the association between social determinants of health (SDOH) and biochemical alcohol relapse in patients who have been transplanted for alcohol-associated liver disease (ALD). Method(s): This single-center, retrospective cohort study examined patients with ALD who were transplanted between 2018-2021. The primary outcome was biochemical alcohol relapse as measured by systematic phosphatidylethanol (PEth) testing. SDOH including race, ethnicity, income, employment, social support, education level, public vs private health insurance, mental health comorbidities, and comorbid illicit substance use were assessed for their association with the outcome using logistic regression analyses. Additionally, temporal trends in biochemical relapse related to the Covid-19 pandemic were evaluated using a cut point of April 2020 to differentiate between pre-pandemic and pandemic groups. Result(s): Seventy-five patients were transplanted for ALD over the study period, of whom 71 had biochemical PEth measurements (95%). Of these 71 patients, 21% were female with a mean (+/-SD) age of 52.9 (+/-10.4) years and 49% of the study population identified as Hispanic ethnicity. At the time of transplant listing, 73% were unemployed, 65% had public insurance, and 62% were married or had a stable co-companion. Over 64 person-years of follow up, 10 (15%) patients had biochemical relapse after transplant. Older age was protective OR=0.94 (95% CI 0.88-0.99;p=0.05), while non-Hispanic white race OR=6.29 (95% CI 1.22-32.51;p=0.03), and prior illicit substance use OR=4.2 (95% CI 1.05-16.90;p=0.04) were associated with an increased risk of relapse. Patients identifying as non-Hispanic white had non-significant trends toward lower household income, decreased social support, and higher rates of comorbid mental illness. Severe acute alcohol hepatitis, time from last drink to listing, SIPAT and AUDIT score were not associated with increased risk of relapse. The risk of relapse increased during the Covid-19 pandemic from 4.3% pre-Covid-19 to 18.8% during Covid-19 with a trend towards statistical significance OR=5.1 (95% CI 0.60-42.8;p=0.13). Conclusion(s): Non-Hispanic white race, younger age, and illicit substance use were associated with increased rates of biochemical alcohol relapse and may be explained by SDOH;however, conventional metrics including >6 months from last drink to listing and lower SIPAT score were not predictive of biochemical relapse.

Jahrestagung der DGSMP und der DGMS

The proceedings contain 380 papers. The topics discussed include: precarious work as risk factor for 5-year increase in depressive symptoms among 2,009 employees in Germany;physical health, wellbeing, and the impact of the Covid-19 pandemic in older adults: results from the LAB60 + Study in Dresden;identifying relevant psychosocial factors in the care of people with dementia: findings of a focus group study with informal caregivers and health professionals;perception of health system responsiveness in Germany among patients with private health insurance;association of modifiable lifestyle factors with cognitive function in the AgeWell.de-trial;factors associated with the interest in smartphone apps for health promotion and disease prevention: results from a cross-sectional, nationwide survey in Germany;mortality, morbidity and health-related outcomes in informal caregivers compared to non-caregivers: a systematic review;the concept auf urban soundscapes in the context of alternative small-scale mobility interventions - the Be-MoVe Project;and WICID 2.0: a framework to integrate evidence and ethics in decision-making and guideline development on non-pharmacological interventions targeting COVID-19 - development and validation.

Telephone medical consultation during the COVID-19 pandemic in Mexico

Background: Telephone consultation has emerged as an alternative method for outpatient medical follow-up during the COVID-19 pandemic, reinforcing the necessary distancing measures. However, there are multiple factors that the medical team must contend with, which could limit the monitoring of patients. Methods: We retrospectively analyzed the remote medical consultation database of a universitybased oncology referral center in northeast Mexico. The telephone calls were made from the medical center by specialized health personnel. The data obtained correspond to the monitoring conducted over six months. Results: We included 1,140 patients in the analysis, of which 79% were women and 21% were men;the median age was 55 years. All individuals had a pathology-confirmed diagnosis of cancer. The main oncological diagnoses were breast, cervix, and prostate cancer which corresponded to 46, 13, and 7% of the cases, respectively. Ninety-four percent of cases corresponded to cancer surveillance, while the remaining 6% were receiving active oncological treatment, administered orally. Ninety-three percent of the patients were from the city of Monterrey and its metropolitan area, 6% came from the rest of the municipalities of the state of Nuevo Leon, and 1% were from other states of the Mexican Republic. Ninety-eight percent of the patients had a public health insurance as a method of coverage for health services, while 2% received care through private health insurance. At remote follow-up, only 53% of the patients responded to the telephone calls, none of them reported a diagnosis or any symptom of SARS-CoV-2 infection. Among the 536 patients who had a telephone communication failure, 68% did not respond to the call after 4 attempts, while in 32% of these cases the number provided by the patient was incorrect or non-existent. Conclusions: The high rates of failure to establish telephone communication documented in our population of patients with cancer is a worrying phenomenon. As the COVID-19 pandemic progresses worldwide, we must seek to establish measures to optimize logistics for more effective remote communication, to achieve the best possible outcomes.

PREVALENCE of LONG COVID in RHEUMATIC DISEASE PATIENTS: ANALYSIS of SAR COVID REGISTRY

Background: Persistent symptoms after acute COVID have been described previously. Main symptoms reported are fatigue, arthralgias, myalgias and mental sickness. Defnition and methods vary widely.1 Objectives: To asses prevalence and related factors to long COVID in a retrospective cohort of patients with rheumatic diseases from Argentina. Methods: A total of 1915 patients were registered from August 18th, 2020 to July 29th, 2021. Patients > 18 years old, with rheumatic disease and confrmed infection by SARS-CoV-2 (antigen or RT-PCR) were included. Those dead, with unknown outcome, wrong date or missing data were excluded. Demographic data, comorbidities, rheumatic disease, and characteristics of SARS-CoV-2 infection were recorded. Long COVID was defned according to NICE guidelines (persistent symptoms for more than 4 weeks, without alternative diagnosis). Long COVID symptoms were defned by rheumatologist. Severity of infection was clas-sifed according to WHO ordinal scale. We used descriptive statistics, univariate model (Student's test, chi square test, ANOVA) and multivariate logistic regression analysis. Results: 230 (12%) had long COVID. Median age was 51 (IQR 40-61]) years, 82% were females, 51% were not caucasian. Median of education was 13.3 years (IQR 12-16), 79 % had private health insurance and 55 % were employed. Nearly half (n=762, 46%) had comorbidities, the most prevalent was hypertension (n=396, 24%). The most frequent rheumatic diseases were rheumatoid arthritis (n=719, 42%) and systemic lupus ery-thematosus (n=280, 16 %). Most were in low activity/remission (79%), used Conventional DMARD (n=773 patients, 45%) and steroids (n=588, 34%) at low dose (n=415, 71%). Main laboratory findings were abnormal D-di-mer (n=94, 28%) and leukopenia (n=93, 26%). Most patients had a WHO ordinal scale < 5 (n=1472, 86%). Median of hospitalization at intensive care unit (ICU) was 8 days [IQR 5, 13]. Treatment for SARS-CoV-2 infection (steroids, anticoagulation, azithromycin, convalescent plasma) was used in 461 (27%) patients. Most of long COVID (n= 152, 69%) reported 1 symptom, the most frequent was fatigue (n= 55, 22%). Figure 1. Univariate analysis is presented in Table 1. In multivariate logistic regression analysis non-caucasian ethnicity OR 1.44 (1.07-1.95), years of education OR 1.05 (1-1.09), treatment with cyclophosphamide OR 11.35 (1.56-112.97), symptoms of COVID-19 OR 13.26 (2.75-242.08), severity scale WHO ≥ 5 OR 2.46 (1.68-3.57), and ICU hospitalization days OR 1.09 (1.05-1.14) were factors associated to long COVID. Conclusion: Prevalence of long COVID was 12%. Non-caucasian ethnicity, higher education, treatment with cyclophosphamide, symptoms of COVID-19, severe disease and ICU hospitalization days were related to long COVID.

Sleep telemedicine in Germany: a developed model

Telemedicine has advanced and grown enormously during the last 10 years. Due to the Sars-CoV2 pandemia the pace of digitalizing diagnostics and therapy in the field of sleep medicine has accelerated. In Germany the main fields of sleep telemedicine are the group of sleep disordered breathing and the group of insomnias. Although there are several initiatives which aim an inventing digital sleep technologies as telemedical recording of relevant data for the diagnostics of obstructive apnea syndrome or digital applications for the treatment of insomnia coordinated approaches are being developed. The German Sleep Society aims on coordinating all initiatives with several approaches. Here the main focus is the standard which a needed for quality aspects. Another aspect is to transform the German health system, which is divided into the public and the private health insurance system, into a more flexible and digital friendly one accepting that sleep medicine is one of the best example to implement digital techniques for telemedicine. The German state of the art in the field of sleep telemedicine will be reflected to open the chance for other countries to have a deeper insight in the challenges and shortcomings for implementing sleep telemedicine in a highly sophisticated health care system.

Consumer preferences for health insurance, in the wake of covid-19: Ranked features and customer segments.

The current study is conceptualized to assess the perception of the general population towards health insurance providers and the policy features, to segment them based on their attitudes. The mixed-method design is used in this study. One fifty health insurance users response were analyzed. The data analysis technique includes focus group discussion, henry garret ranking method, factor analysis and cluster analysis. This study concludes that health insurance providers needs to devise insurance policies incorporating the features of home health, telemedicine and income protection features. The existing users should be offered customization option due to covid-19 to prevent customer switch.

MARCOS technique under intuitionistic fuzzy environment for determining the COVID-19 pandemic performance of insurance companies in terms of healthcare services.

Assessing and ranking private health insurance companies provides insurance agencies, insurance customers, and authorities with a reliable instrument for the insurance decision-making process. Moreover, because the world's insurance sector suffers from a gap of evaluation of private health insurance companies during the COVID-19 outbreak, the need for a reliable, useful, and comprehensive decision tool is obvious. Accordingly, this article aims to identify insurance companies' priority ranking in terms of healthcare services in Turkey during the COVID-19 outbreak through a multi-criteria performance evaluation methodology. Herein, alternatives are evaluated and then ranked as per 7 criteria and assessments of 5 experts. Experts' judgments and assessments are full of uncertainties. We propose a Measurement of Alternatives and Ranking according to the Compromise Solution (MARCOS) technique under an intuitionistic fuzzy environment to rank insurance companies. The outcomes yielded ten insurance companies ranking in terms of healthcare services in the era of COVID-19. The payback period, premium price, and network are determined as the most crucial factors. Finally, a comprehensive sensitivity analysis is performed to verify the proposed methodology's stability and effectiveness. The introduced approach met the insurance assessment problem during the COVID-19 pandemic very satisfactory manner based on sensitivity analysis findings.

COVID-19 Has Increased Medicaid Enrollment, But Short-Term Enrollment Changes Are Unrelated To Job Losses.

The recent coronavirus disease 2019 (COVID-19) global pandemic has resulted in unprecedented job losses in the United States, disrupting health insurance coverage for millions of people. Several models have predicted large increases in Medicaid enrollment among those who have lost jobs, yet the number of Americans who have gained coverage since the pandemic began is unknown. We compiled Medicaid enrollment reports covering the period from March 1 through June 1, 2020, for twenty-six states. We found that in these twenty-six states, Medicaid covered more than 1.7 million additional Americans in roughly a three-month period. Relative changes in Medicaid enrollment differed significantly across states, although enrollment growth was not systemically related to job losses. Our results point to the important effects of state policy differences in the response to COVID-19.

Will you be covered during the next recession? Unequal safety-nets for private health insurance in the United States.

Health insurance coverage for working-age adults in the United States is still predominantly determined by their jobs or their spouse's jobs. This article revealed that SES disparities in access to a spouse's coverage as a safety-net significantly contributed to the inequities in coverage loss during economic instability. Using the longitudinal Survey of Income and Program Participation (1996-2012), this article examines insurance transitions between socioeconomic groups during the two most recent recessions in the United States. The SES disparity in private coverage spiked during periods of high job-loss. Higher SES men's and women's coverages were barely affected as they became insured by their spouses even as they lost their own. Wives' insurance plans played a large role in mitigating declines in higher SES men's coverages during the 2008 recession.