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INTRODUCTION: The availability of low-cost computing and digital telecommunication in the 1980s made telehealth practicable. Telehealth has the capacity to improve healthcare access and outcomes for patients while reducing healthcare costs across a wide range of health conditions and situations. OBJECTIVE: This study compares the adoption, advantages, and challenges of telehealth services between high-income (HICs) and low-and-middle-income countries (LMICs) before and during the COVID-19 pandemic. METHODS: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. The key search terms were: "Telehealth", "Telehealth in HICs", "Telehealth in LMICs", "Telehealth before COVID-19", "Telehealth during COVID-19". We searched exhaustively ProQuest, Scopus, Web of Science, Google Scholar, CINAHL, and EMBASE databases from 2012. Booleans OR/AND were combined with key search terms to increase relevant search results. The literature search and selection process followed the Sample, Phenomena of Interest, Design, Evaluation, and Research (SPIDER) question format. RESULTS: The adoption of telehealth before COVID-19 was generally low in both HICs and LMICs. The impact of COVID-19 accelerated the adoption of telehealth at the facility level but not nationwide in both high-income countries and LMICs. The rapid adoption of telehealth at the facility level in both high-income and LMICs introduced several challenges that are unique to each country and need to be addressed. CONCLUSION: The lack of national policies and regulations is making the adoption of telehealth at the national level challenging in both high and low-middle-income countries. Governments and Stakeholders of healthcare must consider telehealth as a healthcare procedure that should be deployed in clinical working procedures. Primary quantitative and qualitative studies must be conducted to address challenges encountered during the pilot implementation of telehealth services in both high-income countries and LMICs before and during pandemics.
Subject(s)
COVID-19 , Humans , COVID-19/epidemiology , Pandemics , Emergencies , Developing Countries , Health Services AccessibilityABSTRACT
Rural social work is practiced in United States (U.S.) Census-defined rural areas and in small towns and frontier areas throughout the United States. Rural people tend to have many of the same diversities as urban populations but with the added diversity of being from a rural community, and social workers who work with them require deep knowledge of the communities in which they live. Poverty is an ongoing nuanced social problem in rural communities. Rural social work agencies often address needs for housing, food security, and mental health and addiction services as itinerant workers move to work in these industries. Practice in rural areas can be rewarding but also presents some professional challenges. Gaining cultural competence ultimately becomes an important issue if the worker did not grow up in the rural community. All social workers have a professional responsibility to advocate for social justice and equitable distribution of resources. For social work policy advocates, the time is ripe for advocacy for fair telehealth reimbursement because the coronavirus pandemic has placed a spotlight on even the urban area need for telehealth services and has accelerated research on the best practice standards of what can safely and effectively be provided via telehealth. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
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INTRODUCTION: Peritoneal dialysis (PD) is home-based dialysis therapy and therefore a suitable modality for kidney failure patients, particularly, during the COVID-19 pandemic. The present study examined patients' preferences for different PD-related services. METHODS: This was a cross-sectional survey study. Anonymized data from PD patients followed up at a single center in Singapore were collected using an online platform. The study focused on telehealth services, home visits, and monitoring of quality-of-life (QoL). RESULTS: A total of 78 PD patients responded to the survey. The majority of participants were Chinese (76%), married (73%), and between 45 and 65 years old (45%). The in-person visit was preferred over teleconsultation for consultation with nephrologists (68% versus 32%), counseling for kidney disease and dialysis by renal coordinators (59%), whereas the telehealth service was favored over in-person visit for dietary counseling (60%) and medication counseling (64%). Most participants (81%) preferred medication delivery over self-collection, and the acceptable turnaround time was 1 week. Sixty percent would like to have a regular home visit, but 23% refused such visits. The preferred frequency of home visits was one-to-three visits within the first 6 months (74%) and then 6 monthly for subsequent visits (40%). The majority of participants (87%) agreed with QoL monitoring, and the preferred frequency of monitoring varied between 6 monthly (45%) and yearly (40%). Participants also indicated three key areas in research to improve QoL, such as the development of artificial kidneys, portable PD devices, and simplification of PD procedure. Participants also would like to see improvement in two main areas of PD services, such as delivery service for PD solutions and social (instrumental, informational, and emotional) support. CONCLUSIONS: Most PD patients preferred in-person visits with nephrologists or renal coordinators; however, they favored telehealth services with dieticians and pharmacists. PD patients also welcomed home visit service and QoL monitoring. Future studies should confirm these findings.
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Reports an error in "Receipt of telehealth services, receipt and retention of medications for opioid use disorder, and medically treated overdose among Medicare beneficiaries before and during the COVID-19 pandemic" by Christopher M. Jones, Carla Shoff, Kevin Hodges, Carlos Blanco, Jan L. Losby, Shari M. Ling and Wilson M. Compton (JAMA Psychiatry, 2022[Oct], Vol 79[10], 981-992). The Original Investigation published online August 31, 2022, was changed to open access status under the CC-BY license. This article was corrected online. (The following abstract of the original article appeared in record 2023-14077-004). Importance: Federal emergency authorities were invoked during the COVID-19 pandemic to expand use of telehealth for new and continued care, including provision of medications for opioid use disorder (MOUD). Objective: To examine receipt of telehealth services, MOUD (methadone, buprenorphine, and extended-release [ER] naltrexone) receipt and retention, and medically treated overdose before and during the COVID-19 pandemic. Design, Setting, and Participants: This exploratory longitudinal cohort study used data from the US Centers for Medicare & Medicaid Services from September 2018 to February 2021. Two cohorts (before COVID-19 pandemic from September 2018 to February 2020 and during COVID-19 pandemic from September 2019 to February 2021) of Medicare fee-for-service beneficiaries 18 years and older with an International Statistical Classification of Diseases, Tenth Revision, Clinical Modification OUD diagnosis. Exposures: Pre-COVID-19 pandemic vs COVID-19 pandemic cohort demographic characteristics, medical and substance use, and psychiatric comorbidities. Main Outcomes and Measures: Receipt and retention of MOUD, receipt of OUD and behavioral health-related telehealth services, and experiencing medically treated overdose. Results: The pre-COVID-19 pandemic cohort comprised 105 240 beneficiaries;of these, 61 152 (58.1%) were female, 71 152 (67.6%) were aged 45 to 74 years, and 82 822 (79.5%) non-Hispanic White. The COVID-19 pandemic cohort comprised 70 538 beneficiaries;of these, 40 257 (57.1%) were female, 46 793 (66.3%) were aged 45 to 74 years, and 55 510 (79.7%) were non-Hispanic White. During the study period, a larger percentage of beneficiaries in the pandemic cohort compared with the prepandemic cohort received OUD-related telehealth services (13 829 [19.6%] vs 593 [0.6%];P < .001), behavioral health-related telehealth services (28 902 [41.0%] vs 1967 [1.9%];P < .001), and MOUD (8854 [12.6%] vs 11 360 [10.8%];P < .001). The percentage experiencing a medically treated overdose during the study period was similar (18.5% [19 491 of 105 240] in the prepandemic cohort vs 18.4% [13 004 of 70 538] in the pandemic cohort;P = .65). Receipt of OUD-related telehealth services in the pandemic cohort was associated with increased odds of MOUD retention (adjusted odds ratio [aOR], 1.27;95% CI, 1.14-1.41) and lower odds of medically treated overdose (aOR, 0.67;95% CI, 0.63-0.71). Among beneficiaries in the pandemic cohort, those receiving MOUD from opioid treatment programs only (aOR, 0.54;95% CI, 0.47-0.63) and those receiving buprenorphine from pharmacies only (aOR, 0.91;95% CI, 0.84-0.98) had lower odds of medically treated overdose compared with beneficiaries who did not receive MOUD. Conclusions and Relevance: Emergency authorities to expand use of telehealth and provide flexibilities for MOUD provision during the pandemic were used by Medicare beneficiaries initiating an episode of OUD-related care and were associated with improved retention in care and reduced odds of medically treated overdose. Strategies to expand provision of MOUD and increase retention in care are urgently needed. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
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Every effort to ensure that palliative care is effective and meaningful has been touched by technology. Digital health interventions may be used, for example, to facilitate targeted communications to individuals through reminders and health promotion messaging in order to stimulate demand for services and broaden access to health information. Palliative social workers have an opportunity to utilize the various forms of technology to enhance overall care. The rise of telehealth services, including telemedicine and teletherapy, began prior to the COVID-19 pandemic when use escalated rapidly as critical services needed to continue while practicing social distancing for safety and well- being. Additionally, palliative social workers have an opportunity to improve quality of care by using technology to create social connectedness, help minimize loneliness and isolation, and enhance the patient and family's knowledge base. Technology enables a world of information to be readily available at one's fingertips, and this can have significant implications for patients and families. Palliative social workers have the task of incorporating technology into the process of seeing and supporting the strengths and being present to the vulnerabilities of patients and families while identifying when the technology causes harm. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
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The COVID-19 pandemic caused substantial disruptions and changes in mental health service delivery as community mental health clinics had to scramble to implement telehealth services to provide continuity of care under quarantine. For the current study, I conducted in-depth video interviews with ten clients from a community mental health training clinic who transitioned from in-person services to telehealth services. Twenty-one factors related to clients' satisfaction with telehealth services and their perceived barriers to the treatment modality using a grounded theory framework. The majority of participants reported they were satisfied with telehealth but preferred to return to in-person therapy sessions with supplemental telehealth services as needed. Various benefits of telehealth were noted throughout the interviews, including increased ease of access, convenience, and having means of personal comfort during session (e.g., pets, musical instruments, etc.). Participants also identified ways in which telehealth can create barriers to effective therapy, such as privacy concerns, distractions, and technology challenges. Nine guidelines to enhance the effectiveness of telehealth services in the future are provided based on data collected in these interviews. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
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The number of people who cannot visit hospitals and see medical treatment is increasing due to the COVID-19 epidemic around the world. As a result, there is an increasing risk of serious danger to people's health because they are not helped by medical staff at the necessary time. Therefore, this paper attempts to analyze the service model related to non-face-to-face telehealth as an alternative to patients or sick people not being able to visit the hospital. We would like to identify what services occur on the non-face-to-face telehealth platform between medical staff and patients and derive security-related matters that must be considered in the non-face-to-face telehealth environment. By analyzing the derived security factors, we would like to examine how to smoothly provide security in the successful activation of non-face-to-face telehealth services. © 2023 IEEE.
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The purpose of the quality improvement project is to explore the patient experience of telehealth services in a mental health setting during the COVID-19 pandemic. A cross-sectional survey design was deployed in an outpatient psychiatric setting. Forty-five participants completed the survey, and the smartphone was the most frequently used and preferred device for their telehealth service. Participants exhibited a high level of usability for telehealth services (Mean = 5.82, SD = 1.21). Telehealth can be a way to solve the problem of not having enough mental health services available, even though there are potential barriers such as digital literacy and human engagement.
Subject(s)
COVID-19 , Telemedicine , Humans , Mental Health , Cross-Sectional Studies , Pandemics , Outpatients , Patient Outcome AssessmentABSTRACT
BACKGROUND: During the current period of the pandemic, telehealth has been a boon to the healthcare system by providing quality healthcare services at a safe social distance. However, there has been slow progress in telehealth services in low- and middle-income countries with little to no evidence of the cost and effectiveness of such programmes. OBJECTIVE: To provide an overview of the expansion of telehealth in low- and middle-income countries amid the COVID-19 pandemic and identify the challenges, benefits, and costs associated with implementing telehealth services in these countries. METHODS: We performed a literature review using the search term: '*country name* AND ((telemedicine[Title][Abstract]) OR (telehealth[Title][Abstract] OR eHealth[Title][Abstract] OR mHealth[Title][Abstract]))'. Initially, we started with 467 articles, which were reduced to 140 after filtering out duplicates and including only primary research studies. Next, these articles were screened based on established inclusion criteria and 44 articles were finalised to be used in the review. RESULTS: We found telehealth-specific software being used as the most common tool to provide such services. Nine articles reported patient satisfaction of greater than 90% with telehealth services. Moreover, the articles identified the ability to make a correct diagnosis to resolve the condition, efficient mobilisation of healthcare resources, increased accessibility for patients, increased service utilisation, and increased satisfaction as benefits of telehealth services, whereas inaccessibility, low technological literacy, and lack of support, poor security standards and technological concerns, loss of interest by the patients, and income impacts on physicians as challenges. The review could not find articles that explored the financial information on telehealth programme implementation. CONCLUSION: Although telehealth services are growing in popularity, the research gap on the efficacy of telehealth is high in low- and middle-income countries. To better guide the future development of telehealth services, rigorous economic evaluation of telehealth is needed.
Subject(s)
COVID-19 , Telemedicine , Humans , COVID-19/epidemiology , Pandemics , Developing Countries , Delivery of Health CareABSTRACT
Reports an error in "Receipt of telehealth services, receipt and retention of medications for opioid use disorder, and medically treated overdose among Medicare beneficiaries before and during the COVID-19 pandemic" by Christopher M. Jones, Carla Shoff, Kevin Hodges, Carlos Blanco, Jan L. Losby, Shari M. Ling and Wilson M. Compton (JAMA Psychiatry, 2022[Oct], Vol 79[10], 981-992). The Original Investigation published online August 31, 2022, was changed to open access status under the CC-BY license. This article was corrected online. (The following of the original article appeared in record 2023-14077-004). Importance: Federal emergency authorities were invoked during the COVID-19 pandemic to expand use of telehealth for new and continued care, including provision of medications for opioid use disorder (MOUD). Objective: To examine receipt of telehealth services, MOUD (methadone, buprenorphine, and extended-release [ER] naltrexone) receipt and retention, and medically treated overdose before and during the COVID-19 pandemic. Design, Setting, and Participants: This exploratory longitudinal cohort study used data from the US Centers for Medicare & Medicaid Services from September 2018 to February 2021. Two cohorts (before COVID-19 pandemic from September 2018 to February 2020 and during COVID-19 pandemic from September 2019 to February 2021) of Medicare fee-for-service beneficiaries 18 years and older with an International Statistical Classification of Diseases, Tenth Revision, Clinical Modification OUD diagnosis. Exposures: Pre-COVID-19 pandemic vs COVID-19 pandemic cohort demographic characteristics, medical and substance use, and psychiatric comorbidities. Main Outcomes and Measures: Receipt and retention of MOUD, receipt of OUD and behavioral health-related telehealth services, and experiencing medically treated overdose. Results: The pre-COVID-19 pandemic cohort comprised 105 240 beneficiaries;of these, 61 152 (58.1%) were female, 71 152 (67.6%) were aged 45 to 74 years, and 82 822 (79.5%) non-Hispanic White. The COVID-19 pandemic cohort comprised 70 538 beneficiaries;of these, 40 257 (57.1%) were female, 46 793 (66.3%) were aged 45 to 74 years, and 55 510 (79.7%) were non-Hispanic White. During the study period, a larger percentage of beneficiaries in the pandemic cohort compared with the prepandemic cohort received OUD-related telehealth services (13 829 [19.6%] vs 593 [0.6%];P < .001), behavioral health-related telehealth services (28 902 [41.0%] vs 1967 [1.9%];P < .001), and MOUD (8854 [12.6%] vs 11 360 [10.8%];P < .001). The percentage experiencing a medically treated overdose during the study period was similar (18.5% [19 491 of 105 240] in the prepandemic cohort vs 18.4% [13 004 of 70 538] in the pandemic cohort;P = .65). Receipt of OUD-related telehealth services in the pandemic cohort was associated with increased odds of MOUD retention (adjusted odds ratio [aOR], 1.27;95% CI, 1.14-1.41) and lower odds of medically treated overdose (aOR, 0.67;95% CI, 0.63-0.71). Among beneficiaries in the pandemic cohort, those receiving MOUD from opioid treatment programs only (aOR, 0.54;95% CI, 0.47-0.63) and those receiving buprenorphine from pharmacies only (aOR, 0.91;95% CI, 0.84-0.98) had lower odds of medically treated overdose compared with beneficiaries who did not receive MOUD. Conclusions and Relevance: Emergency authorities to expand use of telehealth and provide flexibilities for MOUD provision during the pandemic were used by Medicare beneficiaries initiating an episode of OUD-related care and were associated with improved retention in care and reduced odds of medically treated overdose. Strategies to expand provision of MOUD and increase retention in care are urgently needed. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
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As a result of the COVID-19 pandemic, individuals with neurodevelopmental disabilities (NDD) are engaging more with others in virtual group formats for social, educational, and professional reasons. This study extends prior research by evaluating the efficacy of common behavioral interventions, including behavioral skills training, provided via group video conferencing to teach skills that are important when interacting with others in a virtual format. Four adults with NDD were taught to use their cameras and microphones appropriately and to make encouraging statements to one another while discussing current events and social skills-based lessons via Zoom™. Two of the three skills increased and maintained for all participants even after the experimenter faded the contingencies for appropriate responding. The third skill maintained after the experimenter arranged for the response to produce natural consequences. Tests for generalization across group leads and activities yielded promising results. Findings suggest that adults with NDD benefit from group-based telehealth services to improve skills needed to interact successfully with others in a virtual format.
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Objective: The U.S. Department of Veterans Affairs has a robust telehealth program supported by a training infrastructure for VA clinicians and staff. In fiscal 2019, over 909,000 VA patients received a portion of their VA care through telehealth, and over 60% of VA’s primary and mental health care providers participated in one or more Clinical Video Telehealth (CVT) appointments to a patient’s home. In March 2020, during the initial spread of COVID-19, Veterans Health Administration leadership issued guidance for providers to transition from in-person care to virtual modalities for routine care not requiring a physical encounter. VA’s comprehensive training infrastructure helped providers quickly become capable of delivering CVT care to meet the needs of their patients, and the VA Office of Connected Care Quality and Training (QT) Division adjusted the program as providers’ needs evolved. Design: As clinical staff faced new and increasing demands to respond to needs during the pandemic, the QT Division streamlined existing training programs to deliver essential content and enable providers to acquire necessary telehealth skills more quickly. This included reducing the number of core courses required to become telehealth-capable from four to two by introducing an integrated course. The QT Division reorganized and edited content from other accredited courses to convey key topics. To shorten courses for providers with full schedules, the QT Division removed accreditation from some courses, such as the COVID-19 VA Video Connect for Providers course. Results: The QT Division’s pandemic response resulted in over 80,000 new course completions in the first month and over 20% more primary care and mental health providers conducting CVT visits in the first five months. During this period, the number of CVT appointments increased by over 1,000%. Conclusion: VA’s telehealth training infrastructure, implemented by the QT Division, enabled VA to enter the COVID-19 public health emergency fully prepared for the rapid growth in telehealth care. As CVT became increasingly important during the COVID-19 response, the QT Division made necessary curriculum adjustments to meet provider and patient needs. ____________________________________________________________________________ Fireside Chat with Authors Moderator: Lyle Berkowitz, MD, FACP, FHIMSS, Editor-in-Chief, Telehealth and Medicine Today
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The emergence of COVID-19 has brought a demographic shift in the usage of health services. Patients used to physically visit healthcare facilities but today many of them utilize technology to get advice from doctors. As a result, technology is becoming more widely used and accepted in the healthcare industry. Using the technological acceptance model as a base, this study aims to identify the critical factors that impact patients' adoption of telehealth services. This study found that the intention to adopt technology is dependent on reliability, social norms, schemes, offers, hedonic motivation, convenience, and affordability. These factors comprise 67% of the total variance. Analysis using structural equation modelling revealed that reliability, convenience, and affordability at (beta =0.22, p=***), (beta = 0.31, p=***), (beta =0.33, p=***) shows positive intention by consumers to adopt telehealth services. As a result, the hypotheses H1 (Reliability has a positive influence on the adoption intention of telehealth services), H5 (Convenience has a positive influence on the adoption intention of telehealth services), and H6 ( Affordability has a positive influence on the adoption intention of telehealth services) are accepted. The path coefficient for social norms, hedonic motivation, schemes, and offers was negative and non-significant. Therefore, hypotheses H2 (Social Norms have a positive influence on the adoption intention of telehealth services), H3 (Social Norms have a positive influence on the adoption intention of telehealth services), and H4 (Hedonic Motivation has a positive influence on the adoption intention of telehealth services) were rejected. The findings also demonstrated that telehealth service adoption intentions positively impacted usage behavior.
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BACKGROUND: The adoption of telehealth services has been a challenge in rural communities. The reasons for the slow adoption of such technology-driven services have been attributed to social norms, health care policies, and a lack of infrastructure to support the delivery of services. However, the COVID-19 pandemic-related shutdown of in-person health care services resulted in the usage of telehealth services as a necessity rather than a choice. The pandemic also fast-tracked some needed legislation to allow medical cost reimbursement for remote examination and health care services. As services return to normalcy, it is important to examine whether the usage of telehealth services during the period of a shutdown has changed any of the trends in the acceptance of telehealth as a reliable alternative to traditional in-person health care services. OBJECTIVE: Our aim was to explore whether the temporary shift to telehealth services has changed the attitudes toward the usage of technology-enabled health services in rural communities. METHODS: We examined the Medicaid reimbursement data for the state of Alabama from March 2019 through June 2021. Selecting the telehealth service codes, we explored the adoption rates in 3 phases of the COVID-19 shutdown: prepandemic, pandemic before the rollout of mass vaccination, and pandemic after the rollout of mass vaccination. RESULTS: The trend in telemedicine claims had an opposite pattern to that in nontelemedicine claims across the 3 periods. The distribution of various characteristics of patients who used telemedicine (age group, gender, race, level of rurality, and service provider type) was different across the 3 periods. Claims related to behavior and mental health had the highest rates of telemedicine usage after the onset of the pandemic. The rate of telemedicine usage remained at a high level after the rollout of mass vaccination. CONCLUSIONS: The current trends indicate that adoption of telehealth services is likely to increase postpandemic and that the consumers (patients), service providers, health care establishments, insurance companies, and state and local policies have changed their attitudes toward telehealth. An increase in the use of telehealth could help local and federal governments address the shortage of health care facilities and service providers in underserved communities, and patients can get the much-needed care in a timely and effective manner.
Subject(s)
COVID-19 , Telemedicine , COVID-19/epidemiology , COVID-19/prevention & control , Humans , Medicaid , Pandemics/prevention & control , Rural Population , United StatesABSTRACT
The COVID-19 public health crisis has accelerated the transformation of health systems to become more closely tied to citizens/patients and increasingly dependent on the provision and use of telehealth services. Internet of Things (IoT)-enabled telehealth systems (deployed in conjunction with AI systems) could facilitate the smart transformation of healthcare from a merely reactive system to a data-driven and person-centred system that provides remote health diagnosis, monitoring and treatment services, integrated real-time response solutions, as well as prospective insights. However, the realisation of these health-related benefits requires the processing of vast amounts of data concerning health. These operations and the use of new enabling technologies raises significant legal concerns and questions the applicability of existing/proposed legal concepts. For this reason, the research analyses the adequateness of EU privacy, data protection, data governance, AI governance and other regulatory rules in IoT-enabled (and AI-augmented) telehealth systems. In addition, the research aims to identify technical and organisational measures (best practices), which could facilitate the implementation of normative principles in these information systems in an effective manner. © 2021 ACM.
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Integrated perinatal behavioral healthcare provides opportunities to support women and their babies as part of their primary care medical home. The COVID-19 pandemic required significant changes to be made to medical practices to enhance safety and reduce risk, particularly for vulnerable populations, including pregnant women. Previously established modes of mental health service delivery in the HEART program, an integrated behavioral health program embedded in a primary care clinic for adolescent mothers and their babies, and the PROMISE Clinic, an integrated obstetric behavioral health program that serves pregnant women, quickly pivoted to telehealth services because of the pandemic. HEART serves a racially and ethnically diverse patient population, with over 85% of patients publicly insured. The PROMISE Clinic serves a socioeconomically, racially, and ethnically diverse patient population. Behavioral health clinicians implemented a variety of technology-based services including telephone interventions and support, virtual visits using iPads during medical visits, and video visits that patients accessed from their homes. In HEART, behavioral health visits continued at pre-COVID rates during telehealth adaptations. In the PROMISE clinic, the number of perinatal women seen doubled, the total number of patient contacts tripled, and the missed appointment rate significantly decreased during COVID. In the PROMISE clinic, significantly more White and Hispanic perinatal women were seen during COVID and telehealth adaptations, while significantly fewer Black perinatal women were seen during this period. Further research is indicated to examine patient attitudes towards telehealth services, barriers to treatment for Black women, and outcome data.
El cuidado integrado de salud perinatal y del comportamiento ofrece oportunidades para apoyar a las mujeres y sus bebés como parte central del cuidado médico primario. La pandemia del COVID-19 requirió cambios significativos en las prácticas médicas para mejorar la seguridad y reducir el riesgo, particularmente para grupos de población vulnerables, incluyendo las mujeres embarazadas. Las maneras de ofrecer el servicio de salud mental previamente establecidas en la Clínica para Madres Jóvenes (YMC), una clínica de cuidado primario para madres adolescentes y sus bebés, y la Clínica PROMESA, un equipo integrado de salud obstétrica y del comportamiento, rápidamente cambiaron a los servicios de tele-salud a causa de la pandemia. El personal clínico de salud del comportamiento implementó una variedad de servicios con base en la tecnología, incluyendo intervenciones por teléfono, visitas virtuales llevadas a cabo durante visitas médicas, así como visitas grabadas en video a las que las pacientes tenían acceso desde sus casas. En YMC, las visitas de salud del comportamiento continuaron a los niveles de pre-COVID durante las adaptaciones a la tele-salud. En la Clínica PROMESA, significativamente más mujeres blancas e hispanas perinatales fueron vistas durante las adaptaciones de tele-salud, mientras que significativamente menos mujeres negras perinatales fueron vistas durante este período. Se indica una mayor investigación para examinar las actitudes de las pacientes hacia los servicios de tele-salud, las barreras al tratamiento de mujeres negras y los datos de resultados.
Les soins de santé périnatale intégrés offrent des occasions de soutenir les femmes et leurs bébés dans le contexte de leurs services de soin médical à domicile. La pandémie COVID-19 a exigé des changements importants pour les pratiques médicales afin de renforcer la sécurité et de réduire les risques, particulièrement pour les populations vulnérables, y compris les femmes enceintes. Des modes déjà établis de service de santé mentale dans la Clinique des Jeunes Femmes (Young Mothers Clinic, soit YMC), une clinique de soins primaires pour les mères adolescentes et leurs bébés et la Clinique PROMISE, une équipe de santé obstétrique comportementale intégrée ont vite pivoté vers des services de télésanté à cause de la pandémie. Les cliniciens de santé du comportement ont mis en place une variété de services basés sur la technologie y compris des interventions par téléphone, des visites virtuelles faites durant des visites médicales et des visites par vidéo que les parents ont regardé depuis chez eux. Pour ce qui concerne la YMC les visites de santé comportementale ont continué à des taux pré-COVID durant les adaptations de télésanté. Pour ce qui concerne la clinique PROMISE le nombre de femmes périnatales vues a doublé, le nombre total de contacts aux patientes a triplé, et le taux de rendez-vous manqués a considérablement baissé durant le COVID. A la clinique PROMISE bien plus de femmes périnatales blanches et hispaniques ont été vues durant les adaptions de télésanté, alors que bien moins de femmes périnatales noirs ont été vues durant cette période. Nous indiquons des directions de recherches supplémentaires pour examiner les attitudes de la patiente envers les services de télésanté, les barrières au traitement des femmes noires et les données des résultats.
Subject(s)
COVID-19 , Telemedicine , Adolescent , Delivery of Health Care , Female , Humans , Pandemics , Pregnancy , SARS-CoV-2ABSTRACT
PURPOSE OF REVIEW: The concept of telehealth has been around since the early twentieth century and has been used in different healthcare specialties. However, with the recent COVID-19 pandemic necessitating physical distancing, there has been an increased emphasis and utilization of this mode of healthcare delivery. With increasing reliance on telehealth services, data from investigator groups have brought to light several merits as well as failings of telehealth. RECENT FINDINGS: Telehealth services have been associated with improved healthcare outcomes while remaining a cost-effective mode of healthcare delivery. Improving access and timeliness of care has also been observed by multiple telehealth-related studies. Finally, telehealth services are also anticipated to serve as part of emergency preparedness protocol and have shown to reduce provider-patient supply-demand mismatch, prevalent in certain subspecialties. With these benefits come certain challenges that have been highlighted in the literature. Indiscriminate utilization of telehealth services may widen public health disparities among minority groups and may increase overall healthcare expenditure due to overutilization of care, and the digital platform may jeopardize security of patient data. COVID-19 has been a catalyst in increasing utilization of telehealth services. As we move forward from the current pandemic, lessons learned from the studies demonstrating benefits and challenges associated with telehealth should be taken into account when drafting post-pandemic telehealth policies. Special attention should be paid to ensure that telehealth narrows, and not widens, the currently existing disparities in access to healthcare.
Subject(s)
COVID-19 , Telemedicine , Delivery of Health Care , Humans , Pandemics , SARS-CoV-2ABSTRACT
Using quantitative and qualitative evidence, this study triangulates counselors' perspectives on the use of telemedicine in the context of Opioid Use Disorder (OUD) treatment. A concurrent mixed-methods design examined counselors' experiences with telephone counseling during the COVID-19 pandemic. N = 42 counselors who provided OUD counseling services completed a close-ended, quantitative survey examining their experiences in addressing clients' anxiety, depression, anger, substance use, therapeutic relationship, and substance use recovery using telephone counseling. The survey also assessed comfort, convenience, and satisfaction with telephone counseling. Counselors also completed open-ended responses examining satisfaction, convenience, relationship with patients, substance use, and general feedback with telephone counseling. The synthesis of quantitative and qualitative evidence indicated that a majority of counselors had positive experiences with using telephone counseling to provide services to clients undergoing OUD treatment. Convenience, greater access to clients, and flexibility were among the reasons cited for their positive experience. However, counselors also expressed that the telephone counseling was impersonal, and that some clients may have difficulties accessing appropriate technology for telehealth adoption. Findings suggest that further research with counselors is needed to identify the key elements of an effective integration of telephone counseling with traditional in-person treatment approaches in the post-pandemic era.
Subject(s)
COVID-19 , Opioid-Related Disorders , Counseling , Humans , Opioid-Related Disorders/therapy , Pandemics , SARS-CoV-2 , TelephoneABSTRACT
Background: To identify and document the treatment experiences among patients with opioid use disorder (OUD) in the context of the rapid move from in-person to telephone counseling due to the COVID-19 pandemic. Methods: Participants (n = 237) completed a survey with open-ended questions that included the following domains: (1) satisfaction with telephone counseling, (2) perceived convenience, (3) changes to the therapeutic relationship, (4) perceived impact on substance use recovery, and (5) general feedback. Responses were coded using thematic analysis. Codes were subsequently organized into themes and subthemes (covering 98% of responses). Interrater reliability for coding of participants' responses ranged from 0.89 to 0.95. Results: Overall, patients reported that telephone counseling improved the therapeutic experience. Specifically, 74% of respondents were coded as providing responses consistently indicating "positive valency". "Positive valency" responses include: (1) feeling supported, (2) greater comfort and privacy, (3) increased access to counselors, and (4) resolved transportation barriers. Conversely, "negative valency" responses include: (1) impersonal experience and (2) reduced privacy. Conclusions: Telephone counseling presents its own set of challenges that should be investigated further to improve the quality of care and long-term patient outcomes.
ABSTRACT
The issue of research on patient satisfaction with healthcare services took on a completely new dimension due to the COVID-19 pandemic and the developing telehealth services. This results from the fact that during the pandemic, remote healthcare was often the only possible form of care provision to the patient. The COVID-19 pandemic has substantially accelerated the implementation of remote healthcare in healthcare institutions and made it an essential tool for providing healthcare services. The objective of the literature review was to study the research on patient satisfaction with remote healthcare services prior to and during the pandemic. The study featured a literature review of electronic databases, such as: Medline, ProQuest, PubMED, Ebsco, Google Scholar, WoS. The identified empirical papers were classified in two groups concerning the research on patient satisfaction prior to and during the COVID-19 pandemic, and were divided and descriptively synthesised. Certain limitations to the methodical quality of the research were demonstrated as result of the conducted analyses. It was also ascertained that researchers lack clarity on the method of defining and measuring satisfaction prior to and during the COVID-19 pandemic.