Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 328
Filter
Add filters

Document Type
Year range
1.
Gac Med Mex ; 157(3): 309-312, 2021.
Article in English | MEDLINE | ID: covidwho-1535086

ABSTRACT

INTRODUCTION: Patients with diabetes experience difficulties to maintain glycemic control during the confinement due to the COVID-19 pandemic, with the risk of developing diabetes chronic complications and severe COVID-19. OBJECTIVE: The purpose of this study was to evaluate the conversion of an outpatient diabetes primary care center from a face-to-face care modality to a telemedicine care service by telephone. METHODS: Medical consultations were made by telephone during the initial phase of confinement (April to June 2020), to then continue the follow-up of patients admitted to a multicomponent diabetes care program. RESULTS: A total of 1,118 consultations were made by telephone and follow-up was subsequently continued in 192 patients with type 2 diabetes. Different professionals from different health areas participated, including medical care, diabetes education, nutrition, psychology and podiatry. CONCLUSIONS: Multicomponent diabetes care was successfully transformed from a face-to-face care modality to a telemedicine service. Many primary care patients may be candidates for telemedicine. A redesign of the care model that incorporates telemedicine should be considered to mitigate chronic diseases burden of morbidity and mortality imposed by COVID-19 pandemic, but also for the post-COVID-19 era.


Subject(s)
Ambulatory Care/methods , COVID-19 , Diabetes Mellitus, Type 2/therapy , Telemedicine/methods , Adult , Ambulatory Care/statistics & numerical data , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Primary Health Care/methods , Primary Health Care/statistics & numerical data , Prospective Studies , Telemedicine/statistics & numerical data
2.
Clin Orthop Relat Res ; 479(7): 1417-1425, 2021 07 01.
Article in English | MEDLINE | ID: covidwho-1511052

ABSTRACT

BACKGROUND: Healthcare disparities are well documented across multiple subspecialties in orthopaedics. The widespread implementation of telemedicine risks worsening these disparities if not carefully executed, despite original assumptions that telemedicine improves overall access to care. Telemedicine also poses unique challenges such as potential language or technological barriers that may alter previously described patterns in orthopaedic disparities. QUESTIONS/PURPOSES: Are the proportions of patients who use telemedicine across orthopaedic services different among (1) racial and ethnic minorities, (2) non-English speakers, and (3) patients insured through Medicaid during a 10-week period after the implementation of telemedicine in our healthcare system compared with in-person visits during a similar time period in 2019? METHODS: This was a retrospective comparative study using electronic medical record data to compare new patients establishing orthopaedic care via outpatient telemedicine at two academic urban medical centers between March 2020 and May 2020 with new orthopaedic patients during the same 10-week period in 2019. A total of 11,056 patients were included for analysis, with 1760 in the virtual group and 9296 in the control group. Unadjusted analyses demonstrated patients in the virtual group were younger (median age 57 years versus 59 years; p < 0.001), but there were no differences with regard to gender (56% female versus 56% female; p = 0.66). We used self-reported race or ethnicity as our primary independent variable, with primary language and insurance status considered secondarily. Unadjusted and multivariable adjusted analyses were performed for our primary and secondary predictors using logistic regression. We also assessed interactions between race or ethnicity, primary language, and insurance type. RESULTS: After adjusting for age, gender, subspecialty, insurance, and median household income, we found that patients who were Hispanic (odds ratio 0.59 [95% confidence interval 0.39 to 0.91]; p = 0.02) or Asian were less likely (OR 0.73 [95% CI 0.53 to 0.99]; p = 0.04) to be seen through telemedicine than were patients who were white. After controlling for confounding variables, we also found that speakers of languages other than English or Spanish were less likely to have a telemedicine visit than were people whose primary language was English (OR 0.34 [95% CI 0.18 to 0.65]; p = 0.001), and that patients insured through Medicaid were less likely to be seen via telemedicine than were patients who were privately insured (OR 0.83 [95% CI 0.69 to 0.98]; p = 0.03). CONCLUSION: Despite initial promises that telemedicine would help to bridge gaps in healthcare, our results demonstrate disparities in orthopaedic telemedicine use based on race or ethnicity, language, and insurance type. The telemedicine group was slightly younger, which we do not believe undermines the findings. As healthcare moves toward increased telemedicine use, we suggest several approaches to ensure that patients of certain racial, ethnic, or language groups do not experience disparate barriers to care. These might include individual patient- or provider-level approaches like expanded telemedicine schedules to accommodate weekends and evenings, institutional investment in culturally conscious outreach materials such as advertisements on community transport systems, or government-level provisions such as reimbursement for telephone-only encounters. LEVEL OF EVIDENCE: Level III, therapeutic study.


Subject(s)
Health Services Accessibility , Healthcare Disparities/statistics & numerical data , Minority Groups/statistics & numerical data , Orthopedic Procedures/statistics & numerical data , Telemedicine/statistics & numerical data , Adult , Continental Population Groups/statistics & numerical data , Ethnic Groups/statistics & numerical data , Female , Health Plan Implementation , Healthcare Disparities/ethnology , Humans , Insurance Coverage/statistics & numerical data , Language , Male , Medicaid , Middle Aged , Odds Ratio , Retrospective Studies , Telemedicine/methods , United States
4.
Sci Rep ; 11(1): 21233, 2021 10 27.
Article in English | MEDLINE | ID: covidwho-1493229

ABSTRACT

Reverse transcriptase polymerase chain reaction (RT-PCR) is a key tool to diagnose Covid-19. Yet it may not be the most efficient test in all patients. In this paper, we develop a clinical strategy for prescribing RT-PCR to patients based on data from COVIDOM, a French cohort of 54,000 patients with clinically suspected Covid-19, including 12,810 patients tested by RT-PCR. We use a machine-learning algorithm (decision tree) in order to predict RT-PCR results based on the clinical presentation. We show that symptoms alone are sufficient to predict RT-PCR outcome with a mean average precision of 86%. We identify combinations of symptoms that are predictive of RT-PCR positivity (90% for anosmia/ageusia) or negativity (only 30% of RT-PCR+ for a subgroup with cardiopulmonary symptoms): in both cases, RT-PCR provides little added diagnostic value. We propose a prescribing strategy based on clinical presentation that can improve the global efficiency of RT-PCR testing.


Subject(s)
COVID-19 Nucleic Acid Testing/methods , COVID-19/diagnosis , SARS-CoV-2 , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/diagnostic imaging , COVID-19/epidemiology , COVID-19 Nucleic Acid Testing/statistics & numerical data , Cohort Studies , Female , France/epidemiology , Humans , Male , Middle Aged , Pandemics , Predictive Value of Tests , Retrospective Studies , Telemedicine/methods , Telemedicine/statistics & numerical data , Young Adult
6.
BMC Cancer ; 21(1): 1094, 2021 Oct 11.
Article in English | MEDLINE | ID: covidwho-1463236

ABSTRACT

BACKGROUND: To ensure safe delivery of oncologic care during the COVID-19 pandemic, telemedicine has been rapidly adopted. However, little data exist on the impact of telemedicine on quality and accessibility of oncologic care. This study assessed whether conducting an office visit for thoracic oncology patients via telemedicine affected time to treatment initiation and accessibility. METHODS: This was a retrospective cohort study of patients with thoracic malignancies seen by a multidisciplinary team during the first surge of COVID-19 cases in Philadelphia (March 1 to June 30, 2020). Patients with an index visit for a new phase of care, defined as a new diagnosis, local recurrence, or newly discovered metastatic disease, were included. RESULTS: 240 distinct patients with thoracic malignancies were seen: 132 patients (55.0%) were seen initially in-person vs 108 (45.0%) via telemedicine. The majority of visits were for a diagnosis of a new thoracic cancer (87.5%). Among newly diagnosed patients referred to the thoracic oncology team, the median time from referral to initial visit was significantly shorter amongst the patients seen via telemedicine vs. in-person (median 5.0 vs. 6.5 days, p < 0.001). Patients received surgery (32.5%), radiation (24.2%), or systemic therapy (30.4%). Time from initial visit to treatment initiation by modality did not differ by telemedicine vs in-person: surgery (22 vs 16 days, p = 0.47), radiation (27.5 vs 27.5 days, p = 0.86, systemic therapy (15 vs 13 days, p = 0.45). CONCLUSIONS: Rapid adoption of telemedicine allowed timely delivery of oncologic care during the initial surge of the COVID19 pandemic by a thoracic oncology multi-disciplinary clinic.


Subject(s)
COVID-19/epidemiology , Health Services Accessibility , Pandemics , Telemedicine/organization & administration , Thoracic Neoplasms/therapy , Time-to-Treatment , Aged , Female , Humans , Male , Middle Aged , Neoplasm Recurrence, Local , Patient Care Team , Philadelphia/epidemiology , Quality of Health Care , Referral and Consultation , Retrospective Studies , Telemedicine/standards , Telemedicine/statistics & numerical data , Thoracic Neoplasms/epidemiology , Thoracic Neoplasms/pathology , Time Factors
10.
Healthc Policy ; 17(1): 73-90, 2021 08.
Article in English | MEDLINE | ID: covidwho-1431156

ABSTRACT

OBJECTIVE: This study documents the adoption of telehealth by various types of primary healthcare (PHC) providers working in teaching PHC clinics in Quebec during the COVID-19 pandemic. It also identifies the perceived advantages and disadvantages of telehealth. METHOD: A cross-sectional study was conducted between May and August 2020. The e-survey was completed by 48/50 teaching primary care clinics representing 603/1,357 (44%) PHC providers. RESULTS: Telephone use increased the most, becoming the principal virtual modality of consultation, during the pandemic. Video consultations increased, with variations by type of PHC provider: between 2% and 16% reported using it "sometimes." The main perceived advantages of telehealth were minimizing the patient's need to travel, improved efficiency and reduction in infection transmission risk. The main disadvantages were the lack of physical exam and difficulties connecting with some patients. CONCLUSION: The variation in telehealth adoption by type of PHC provider may inform strategies to maximize the potential of telehealth and help create guidelines for its use in more normal times.


Subject(s)
COVID-19/diagnosis , COVID-19/therapy , Health Personnel/statistics & numerical data , Patient Acceptance of Health Care/statistics & numerical data , Primary Health Care/organization & administration , Primary Health Care/statistics & numerical data , Telemedicine/organization & administration , Telemedicine/statistics & numerical data , Adult , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Pandemics , Quebec , SARS-CoV-2
11.
Pediatr Clin North Am ; 68(5): 1119-1131, 2021 10.
Article in English | MEDLINE | ID: covidwho-1428326

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic has caused severe economic and health impacts in the United States, and the impact is disproportionately more in socially disadvantages areas. The available data, albeit limited in children, suggest that the initial concerns of the potential of serious impact of COVID-19 illness in children with asthma are unproven so far. The reduction in asthma morbidities is due to improved adherence, COVID-19 control measures, school closures, and decreased exposure to allergens and viral infections in children. During the pandemic, asthma guidelines were updated to guide physicians in asthma care. In the face of unprecedented time, it is important to be vigilant, adhere to treatment guidelines, and implement preventive measures to eradicate the virus and improve outcomes in children with asthma.


Subject(s)
Asthma/enzymology , Asthma/therapy , COVID-19/epidemiology , Patient Education as Topic/methods , School Health Services/organization & administration , COVID-19/therapy , Child , Humans , Medication Adherence , Schools/organization & administration , Telemedicine/statistics & numerical data , United States
12.
PLoS One ; 16(9): e0257270, 2021.
Article in English | MEDLINE | ID: covidwho-1416892

ABSTRACT

BACKGROUND: The prominence of telemental health, including providing care by video call and telephone, has greatly increased during the COVID-19 pandemic. However, there are clear variations in uptake and acceptability, and concerns that digital exclusion may exacerbate previous inequalities in access to good quality care. Greater understanding is needed of how service users experience telemental health, and what determines whether they engage and find it acceptable. METHODS: We conducted a collaborative framework analysis of data from semi-structured interviews with a sample of people already experiencing mental health problems prior to the pandemic. Data relevant to participants' experiences and views regarding telemental health during the pandemic were identified and extracted. Data collection and analysis used a participatory, coproduction approach where researchers with relevant lived experience, contributed to all stages of data collection, analysis and interpretation of findings alongside clinical and academic researchers. FINDINGS: The experiences and preferences regarding telemental health care of the forty-four participants were dynamic and varied across time and settings, as well as between individuals. Participants' preferences were shaped by reasons for contacting services, their relationship with care providers, and both parties' access to technology and their individual preferences. While face-to-face care tended to be the preferred option, participants identified benefits of remote care including making care more accessible for some populations and improved efficiency for functional appointments such as prescription reviews. Participants highlighted important challenges related to safety and privacy in online settings, and gave examples of good remote care strategies they had experienced, including services scheduling regular phone calls and developing guidelines about how to access remote care tools. DISCUSSION: Participants in our study have highlighted advantages of telemental health care, as well as significant limitations that risk hindering mental health support and exacerbate inequalities in access to services. Some of these limitations are seen as potentially removable, for example through staff training or better digital access for staff or service users. Others indicate a need to maintain traditional face-to-face contact at least for some appointments. There is a clear need for care to be flexible and individualised to service user circumstances and preferences. Further research is needed on ways of minimising digital exclusion and of supporting staff in making effective and collaborative use of relevant technologies.


Subject(s)
COVID-19/prevention & control , Delivery of Health Care/statistics & numerical data , Mental Health Services/statistics & numerical data , Mental Health/statistics & numerical data , Telemedicine/statistics & numerical data , Adolescent , Adult , COVID-19/epidemiology , COVID-19/virology , Delivery of Health Care/methods , Female , Health Personnel/statistics & numerical data , Humans , Male , Mental Health/standards , Middle Aged , Pandemics , Quality of Health Care/standards , Quality of Health Care/statistics & numerical data , SARS-CoV-2/physiology , Surveys and Questionnaires/statistics & numerical data , Telemedicine/methods , Young Adult
13.
J Urol ; 206(6): 1469-1479, 2021 12.
Article in English | MEDLINE | ID: covidwho-1410198

ABSTRACT

PURPOSE: We examined changes in urological care delivery due to COVID-19 in the U.S. based on patient, practice, and local/regional demographic and pandemic response features. MATERIALS AND METHODS: We analyzed real-world data from the American Urological Association Quality (AQUA) Registry collected from electronic health record systems. Data represented 157 outpatient urological practices and 3,165 providers across 48 U.S. states and territories, including 3,297,721 unique patients, 12,488,831 total outpatient visits and 2,194,456 procedures. The primary outcome measure was the number of outpatient visits and procedures performed (inpatient or outpatient) per practice per week, measured from January 2019 to February 2021. RESULTS: We found large (>50%) declines in outpatient visits from March 2020 to April 2020 across patient demographic groups and states, regardless of timing of state stay-at-home orders. Nonurgent outpatient visits decreased more across various nonurgent procedures (49%-59%) than for procedures performed for potentially urgent diagnoses (38%-52%); surgical procedures for nonurgent conditions also decreased more (43%-79%) than those for potentially urgent conditions (43%-53%). African American patients had similar decreases in outpatient visits compared with Asians and Caucasians, but also slower recoveries back to baseline. Medicare-insured patients had the steepest declines (55%), while those on Medicaid and government insurance had the lowest percentage of recovery to baseline (73% and 69%, respectively). CONCLUSIONS: This study provides real-world evidence on the decline in urological care across demographic groups and practice settings, and demonstrates a differential impact on the utilization of urological health services by demographics and procedure type.


Subject(s)
COVID-19/prevention & control , Communicable Disease Control/standards , Pandemics/prevention & control , Urologic Diseases/therapy , Urology/statistics & numerical data , Adolescent , Adult , Aged , Ambulatory Care/standards , Ambulatory Care/statistics & numerical data , Ambulatory Care/trends , COVID-19/epidemiology , COVID-19/transmission , Female , Humans , Male , Middle Aged , Patient Acceptance of Health Care/statistics & numerical data , Practice Patterns, Physicians'/standards , Practice Patterns, Physicians'/statistics & numerical data , Practice Patterns, Physicians'/trends , Telemedicine/standards , Telemedicine/statistics & numerical data , Telemedicine/trends , United States/epidemiology , Urologic Surgical Procedures/standards , Urologic Surgical Procedures/statistics & numerical data , Urologic Surgical Procedures/trends , Urology/standards , Urology/trends , Young Adult
14.
West J Emerg Med ; 22(5): 1028-1031, 2021 Aug 19.
Article in English | MEDLINE | ID: covidwho-1405510

ABSTRACT

INTRODUCTION: The novel coronavirus disease 2019 (COVID-19) created challenges with access to care including increased burden on healthcare systems and potential exposure risks for vulnerable patients. To address these needs, Rush University Medical Center created a virtual, urgent care program specifically designed to address these challenges during the COVID-19 pandemic. METHODS: This was a retrospective study analyzing adult patients with COVID-19-related telemedicine visits performed between March 1-June 30, 2020. COVID-19-related telemedicine visits refer to those who used the "Concern for Coronavirus" module. We assessed the total number of telemedicine visits using this module, percentage with a subsequent emergency department (ED) visit within seven days, and outcomes (ie, hospitalization status, intubation, and death) of patients who presented to the ED for evaluation. Data are presented using descriptive statistics. RESULTS: A total of 2,974 adult patients accessed the program via the COVID-19 module over the four-month period. Of those, 142 patients (4.8%) had an ED visit within seven days. Only 14 patients (0.5%) required admission. One patient was intubated, and there were no deaths among the telemedicine population. CONCLUSION: The data suggests that telemedicine may be a safe and effective way to screen and treat patients with possible COVID-19, while reducing potential burdens on EDs.


Subject(s)
Ambulatory Care/statistics & numerical data , COVID-19 , Mass Screening/methods , Patient Acceptance of Health Care/statistics & numerical data , Telemedicine/statistics & numerical data , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/prevention & control , Female , Humans , Male , Middle Aged , Pandemics , Retrospective Studies , SARS-CoV-2
15.
South Med J ; 114(9): 593-596, 2021 09.
Article in English | MEDLINE | ID: covidwho-1395358

ABSTRACT

OBJECTIVES: Since the onset of the coronavirus disease 2019 (COVID-19) pandemic, many US clinics have shifted some or all of their practice from in-person to virtual visits. In this study, we assessed the use of telehealth among primary care and specialty clinics, by targeting healthcare administrators via multiple channels. METHODS: Using an online survey, we assessed the use of, barriers to, and reimbursement for telehealth. Respondents included clinic administrators (chief executive officers, vice presidents, directors, and senior-level managers). RESULTS: A total of 85 complete responses were recorded, 79% of which represented solo or group practices and 63% reported a daily patient census >50. The proportion of clinics that delivered ≥50% of their consults using telehealth increased from 16% in March to 42% in April, 35% in May, and 30% in June. Clinics identified problems with telehealth reimbursement; although 63% of clinics reported that ≥75% of their telehealth consults were reimbursed, only 51% indicated that ≥75% of their telehealth visits were reimbursed at par with in-person office visits. Sixty-five percent of clinics reported having basic or foundational telehealth services, whereas only 9% of clinics reported advanced telehealth maturity. Value-based care participating clinics were more likely to report advanced telehealth services (27%), compared with non-value-based care clinics (3%). CONCLUSIONS: These findings highlight the adaptability of clinics to quickly transition and adopt telehealth. Uncertainty about reimbursement and policy changes may make the shift temporal, however.


Subject(s)
COVID-19/prevention & control , Medicine/statistics & numerical data , Mental Health Services/statistics & numerical data , Primary Health Care/statistics & numerical data , Telemedicine/statistics & numerical data , Health Care Surveys , Humans , Medicine/methods , Primary Health Care/methods , SARS-CoV-2 , Telemedicine/methods , Texas
16.
Rheumatol Int ; 41(10): 1755-1761, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1384393

ABSTRACT

The SARS-CoV-2 global pandemic resulted in major disruptions to medical care. We aimed to understand changes in outpatient care delivery and use of telemedicine in U.S. rheumatology practices during this period. Rheumatology Informatics System Effectiveness (RISE) is a national, EHR-enabled registry that passively collects data on all patients seen by participating practices. Included practices were required to have been participating in RISE from January 2019 through August 2020 (N = 213). We compared total visit counts and telemedicine visits during March-August 2020 to March-August 2019 and stratified by locations in states with shelter-in-place (SIP) orders. We assessed characteristics of patients within each practice, including primary rheumatic diagnosis and disease activity scores, where available. We included 213 practices with 945,160 patients. Overall, we found visit counts decreased by 10.9% (from 1,302,455 to 1,161,051) between March and August 2020 compared to 2019; this drop was most dramatic during the month of April (- 22.3%). Telemedicine visits increased from 0% to a mean of 12.1%. Practices in SIP states had more dramatic decreases in visits, (11.5% vs. 5.3%). We found no major differences in primary diagnoses or disease activity across the two periods. We detected a meaningful decrease in rheumatology visits in March-August 2020 during the SARS-CoV-2 global pandemic compared to the year prior with a concomitant increase in the use of telemedicine. Future work should address possible adverse consequences to patient outcomes due to decreased contact with clinicians.


Subject(s)
Health Services Accessibility/statistics & numerical data , Office Visits/statistics & numerical data , Rheumatology/organization & administration , Telemedicine/statistics & numerical data , Adult , Aged , COVID-19/epidemiology , Female , Humans , Male , Middle Aged , Pandemics , Registries , Rheumatology/statistics & numerical data , SARS-CoV-2 , United States/epidemiology
18.
BJOG ; 128(9): 1464-1474, 2021 08.
Article in English | MEDLINE | ID: covidwho-1337350

ABSTRACT

OBJECTIVE: To compare outcomes before and after implementation of medical abortion (termination of pregnancy) without ultrasound via telemedicine. DESIGN: Cohort analysis. SETTING: The three main abortion providers. POPULATION OR SAMPLE: Medical abortions at home at ≤69 days' gestation in two cohorts: traditional model (in-person with ultrasound, n = 22 158) from January to March 2020 versus telemedicine-hybrid model (either in person or via telemedicine without ultrasound, n = 29 984, of whom 18 435 had no-test telemedicine) between April and June 2020. Sample (n = 52 142) comprises 85% of all medical abortions provided nationally. METHODS: Data from electronic records and incident databases were used to compare outcomes between cohorts, adjusted for baseline differences. MAIN OUTCOME MEASURES: Treatment success, serious adverse events, waiting times, gestation at treatment, acceptability. RESULTS: Mean waiting time from referral to treatment was 4.2 days shorter in the telemedicine-hybrid model and more abortions were provided at ≤6 weeks' gestation (40% versus 25%, P < 0.001). Treatment success (98.8% versus 98.2%, P > 0.999), serious adverse events (0.02% versus 0.04%, P = 0.557) and incidence of ectopic pregnancy (0.2% versus 0.2%, P = 0.796) were not different between models. In the telemedicine-hybrid model, 0.04% were estimated to be over 10 weeks' gestation at the time of the abortion; all were completed safely at home. Within the telemedicine-hybrid model, effectiveness was higher with telemedicine than in-person care (99.2% versus 98.1%, P < 0.001). Acceptability of telemedicine was high (96% satisfied) and 80% reported a future preference for telemedicine. CONCLUSIONS: A telemedicine-hybrid model for medical abortion that includes no-test telemedicine and treatment without an ultrasound is effective, safe, acceptable and improves access to care. TWEETABLE ABSTRACT: Compelling evidence from 52 142 women shows no-test telemedicine abortion is safe, effective and improves care.


Subject(s)
Abortion, Induced/methods , Telemedicine/methods , Abortion, Induced/statistics & numerical data , COVID-19/epidemiology , Case-Control Studies , Cohort Studies , England/epidemiology , Female , Humans , Pandemics , Pregnancy , SARS-CoV-2 , Telemedicine/statistics & numerical data , Ultrasonography, Prenatal/statistics & numerical data
19.
Riv Psichiatr ; 56(4): 198-204, 2021.
Article in English | MEDLINE | ID: covidwho-1325470

ABSTRACT

The covid-19 lockdown forced psychotherapists to use videoconferencing psychotherapy (VCP). There is little literature on the relationship between VCP and the theoretical orientation of the psychotherapist. The aim of our research work is to explore to what extent the Italian therapists used VCP and how they experienced the change in setting during lockdown. A sample of psychotherapists completed an on-line questionnaire including data about any previous experience of remote work, information on changes in setting during lockdown and their opinions on this experience. In the second phase, a statistical analysis of the data collected was performed with SPSS. The most represented theoretical orientations are psychoanalytic, Gestalt, systemic-relational and psychodynamic. Almost all the respondents had chosen to change the setting, opting for remote work via video calls, with no differences in terms of theoretical orientation and age group. Psychotherapeutic orientation seems to affect the type of difficulties encountered. The scientific literature on remote psychotherapy (VCP) so far does not correlate it with any specific theoretical-clinical model. Our research work offers some preliminary hypotheses about potential correlations between setting variations with the theoretical-clinical models.


Subject(s)
Attitude of Health Personnel , COVID-19 , Pandemics , Psychotherapists/psychology , Psychotherapy/methods , SARS-CoV-2 , Telemedicine/methods , Adult , Aged , Appointments and Schedules , Continuity of Patient Care , Female , Humans , Italy/epidemiology , Male , Middle Aged , Models, Theoretical , Personal Satisfaction , Quarantine , Surveys and Questionnaires , Telemedicine/statistics & numerical data , Telephone , Videoconferencing , Workload
20.
Headache ; 61(7): 1123-1131, 2021 07.
Article in English | MEDLINE | ID: covidwho-1324996

ABSTRACT

OBJECTIVE: To assess telehealth practice for headache visits in the United States. BACKGROUND: The rapid roll out of telehealth during the COVID-19 pandemic impacted headache specialists. METHODS: American Headache Society (AHS) members were emailed an anonymous survey (9/9/20-10/12/20) to complete if they had logged ≥2 months or 50+ headache visits via telehealth. RESULTS: Out of 1348 members, 225 (16.7%) responded. Most were female (59.8%; 113/189). Median age was 47 (interquartile range [IQR] 37-57) (N = 154). The majority were MD/DOs (83.7%; 159/190) or NP/PAs (14.7%; 28/190), and most (65.1%; 123/189) were in academia. Years in practice were 0-3: 28; 4-10: 58; 11-20: 42; 20+: 61. Median number of telehealth visits was 120 (IQR 77.5-250) in the prior 3 months. Respondents were "comfortable/very comfortable" treating via telehealth (a) new patient with a chief complaint of headache (median, IQR 4 [3-5]); (b) follow-up for migraine (median, IQR 5 [5-5]); (c) follow-up for secondary headache (median, IQR 4 [3-4]). About half (51.1%; 97/190) offer urgent telehealth. Beyond being unable to perform procedures, top barriers were conducting parts of the neurologic exam (157/189), absence of vital signs (117/189), and socioeconomic/technologic barriers (91/189). Top positive attributes were patient convenience (185/190), reducing patient travel stress (172/190), patient cost reduction (151/190), flexibility with personal matters (128/190), patient comfort at home (114/190), and patient medications nearby (103/190). Only 21.3% (33/155) of providers said telehealth visit length differed from in-person visits, and 55.3% (105/190) believe that the no-show rate improved. On a 1-5 Likert scale, providers were "interested"/"very interested" in digitally prescribing headache apps (median 4, IQR 3-5) and "interested"/"very interested" in remotely monitoring patient symptoms (median 4, IQR 3-5). CONCLUSIONS: Respondents were comfortable treating patients with migraine via telehealth. They note positive attributes for patients and how access may be improved. Technology innovations (remote vital signs, digitally prescribing headache apps) and remote symptom monitoring are areas of interest and warrant future research.


Subject(s)
Attitude of Health Personnel , Headache Disorders/diagnosis , Headache Disorders/therapy , Physicians/statistics & numerical data , Telemedicine/statistics & numerical data , Adult , Female , Humans , Male , Middle Aged , Migraine Disorders/diagnosis , Societies, Medical/statistics & numerical data , United States
SELECTION OF CITATIONS
SEARCH DETAIL
...