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1.
Lancet Psychiatry ; 9(1): 8-9, 2022 01.
Article in English | MEDLINE | ID: covidwho-1569159
3.
Ann Cardiol Angeiol (Paris) ; 70(5): 317-321, 2021 Nov.
Article in French | MEDLINE | ID: covidwho-1525669

ABSTRACT

Telemedicine has been recognized since 2010 as a constitutive element of care, however, it was not until 2016 that the first national experiments were able to be launched with the aim of validating a framework allowing a possible rapid passage in the common right. These experiments, which are due to end in December 2021, have succeeded in involving more than 100,000 patients, mainly suffering from cardiac pathologies. The arrival of COVID-19 has made it possible to measure the usefulness of practices at a distance both from teleconsultation and telemonitoring, with the appearance of organizational and technical innovations that must now be maintained and developed in order to integrate the telemedicine of tomorrow into our actual medicine.


Subject(s)
COVID-19/epidemiology , Pandemics , Telemedicine/organization & administration , COVID-19/therapy , Diabetes Mellitus/therapy , Heart Failure/therapy , Humans , Kidney Failure, Chronic/therapy , Patient Satisfaction , Remote Consultation/methods , Remote Consultation/organization & administration , Respiratory Insufficiency/therapy , Telemedicine/economics , Telemedicine/trends
8.
Orthopedics ; 44(5): 274-279, 2021.
Article in English | MEDLINE | ID: covidwho-1444386

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic forced many institutions to implement telemedicine to facilitate continued patient care at a distance. The quality of patient care with telemedicine in orthopedic oncology has not been assessed. Between March and June 2020, a telephone survey of 64 patients was conducted in an academic orthopedic oncology practice. Patient satisfaction was assessed with a Likert scale metric, open-ended feedback, and direct comparisons between telemedicine and in-office visits. Billing and collection financial data of the telemedicine cohort and of a separate cohort of in-office visits during the same time period were compared. The clinical competency of telemedicine visits was measured by delayed or missed diagnoses and surgical site infections that may be attributable to lack of an in-person physical examination. Overall, patients were largely satisfied with their telemedicine experience. More than 90% of patients described telemedicine as equal to or better than in-office visits regarding convenience, time, privacy, and overall quality. Patients reported that better assessment of their physical condition may be indicated, particularly in early postoperative and early sarcoma surveillance visits. Two of 64 patients had adverse events (both local recurrences) potentially attributable to lack of an in-person physical examination. Institutional financial reimbursement of telemedicine visits was comparable to that of in-office visits. These findings have supported continued use of telemedicine in our practice, particularly for patients traveling significant distance and those returning for sarcoma surveillance. However, the limitations of lack of an in-person physical examination should be considered on a case-by-case basis. [Orthopedics. 2021;44(5):274-279.].


Subject(s)
COVID-19 , Orthopedics/methods , Patient Satisfaction , Telemedicine/methods , Ambulatory Care/statistics & numerical data , COVID-19/epidemiology , Humans , Orthopedics/trends , Pandemics/prevention & control , Physical Examination , SARS-CoV-2 , Telemedicine/trends
9.
PLoS One ; 16(9): e0258015, 2021.
Article in English | MEDLINE | ID: covidwho-1443852

ABSTRACT

BACKGROUND: During the COVID-19 pandemic, telehealth became a vital resource to contain the virus's spread and ensure continuity of care of patients with a chronic condition, notably arterial hypertension and heart disease. This paper reports the experience based on a telehealth platform used at scale to manage chronic disease patients in the Italian community. METHODS AND FINDINGS: Patients' health status was remotely monitored through ambulatory blood pressure monitoring (ABPM), resting or ambulatory electrocardiogram (ECG), spirometry, sleep oximetry, and cardiorespiratory polysomnography performed in community pharmacies or general practitioners' offices. Patients also monitored their blood pressure (BP), heart rate (HR), blood oxygen saturation (SpO2), body temperature, body weight, waist circumference, blood glucose, and lipids at home through a dedicated smartphone app. All data conveyed to the web-based telehealth platform were used to manage critical patients by doctors promptly. Data were analyzed and compared across three consecutive periods of 2 months each: i) before the national lockdown, ii) during the lockdown (from March 9 to May 17, 2020), and iii) after the end of the containment measures. Overall, 13,613 patients visited community pharmacies or doctors' offices. The number of overall tests dropped during and rose after the lockdown. The overall proportion of abnormal tests was larger during the outbreak. A significant increase in the prevalence of abnormal ECGs due to myocardial ischemia, contrasted by a significantly improved BP control, was observed. The number of home users and readings exchanged increased during the pandemic. In 226 patients, a significant increase in the proportion of SpO2 readings and a significant reduction in the entries for all other parameters, except BP, was observed. The proportion of abnormal SpO2 and BP values was significantly lower during the lockdown. Following the lockdown, the proportion of abnormal body weight or waist circumference values increased. CONCLUSIONS: Our study results support the usefulness of a telehealth solution to detect deterioration of the health status during the COVID-19 pandemic. TRIAL REGISTRATION: The study is registered with ClinicalTrials.gov at number NCT03781401.


Subject(s)
COVID-19/psychology , Disease Management , Telemedicine/trends , Adult , COVID-19/therapy , Chronic Disease/epidemiology , Chronic Disease/therapy , Communicable Disease Control , Female , Humans , Italy/epidemiology , Male , Middle Aged , Pandemics/prevention & control , Physical Distancing , SARS-CoV-2/pathogenicity
10.
Circ Heart Fail ; 14(10): e008573, 2021 10.
Article in English | MEDLINE | ID: covidwho-1443687

ABSTRACT

BACKGROUND: An unprecedented shift to remote heart failure outpatient care occurred during the coronavirus disease 2019 (COVID-19) pandemic. Given challenges inherent to remote care, we studied whether remote visits (video or telephone) were associated with different patient usage, clinician practice patterns, and outcomes. METHODS: We included all ambulatory cardiology visits for heart failure at a multisite health system from April 1, 2019, to December 31, 2019 (pre-COVID) or April 1, 2020, to December 31, 2020 (COVID era), resulting in 10 591 pre-COVID in-person, 7775 COVID-era in-person, 1009 COVID-era video, and 2322 COVID-era telephone visits. We used multivariable logistic and Cox proportional hazards regressions with propensity weighting and patient clustering to study ordering practices and outcomes. RESULTS: Compared with in-person visits, video visits were used more often by younger (mean 64.7 years [SD 14.5] versus 74.2 [14.1]), male (68.3% versus 61.4%), and privately insured (45.9% versus 28.9%) individuals (P<0.05 for all). Remote visits were more frequently used by non-White patients (35.8% video, 37.0% telephone versus 33.2% in-person). During remote visits, clinicians were less likely to order diagnostic testing (odds ratio, 0.20 [0.18-0.22] video versus in-person, 0.18 [0.17-0.19] telephone versus in-person) or prescribe ß-blockers (0.82 [0.68-0.99], 0.35 [0.26-0.47]), mineralocorticoid receptor antagonists (0.69 [0.50-0.96], 0.48 [0.35-0.66]), or loop diuretics (0.67 [0.53-0.85], 0.45 [0.37-0.55]). During telephone visits, clinicians were less likely to prescribe ACE (angiotensin-converting enzyme) inhibitor/ARB (angiotensin receptor blockers)/ARNIs (angiotensin receptor-neprilysin inhibitors; 0.54 [0.40-0.72]). Telephone visits but not video visits were associated with higher rates of 90-day mortality (1.82 [1.14-2.90]) and nonsignificant trends towards higher rates of 90-day heart failure emergency department visits (1.34 [0.97-1.86]) and hospitalizations (1.36 [0.98-1.89]). CONCLUSIONS: Remote visits for heart failure care were associated with reduced diagnostic testing and guideline-directed medical therapy prescription. Telephone but not video visits were associated with increased 90-day mortality.


Subject(s)
COVID-19 , Cardiologists/trends , Heart Failure/therapy , Practice Patterns, Physicians'/trends , Telemedicine/trends , Aged , Aged, 80 and over , Diagnostic Techniques and Procedures/trends , Drug Prescriptions , Drug Utilization/trends , Emergency Service, Hospital/trends , Female , Guideline Adherence/trends , Heart Failure/diagnosis , Heart Failure/mortality , Heart Failure/physiopathology , Hospitalization/trends , Humans , Male , Middle Aged , Practice Guidelines as Topic , Telephone/trends , Time Factors , Treatment Outcome , Videoconferencing/trends
11.
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
12.
Med Care ; 59(8): 694-698, 2021 08 01.
Article in English | MEDLINE | ID: covidwho-1393508

ABSTRACT

BACKGROUND: Concerns exist regarding exacerbation of existing disparities in health care access with the rapid implementation of telemedicine during the coronavirus disease 2019 (COVID-19) pandemic. However, data on pre-existing disparities in telemedicine utilization is currently lacking. OBJECTIVE: We aimed to study: (1) the prevalence of outpatient telemedicine visits before the COVID-19 pandemic by patient subgroups based on age, comorbidity burden, residence rurality, and median household income; and (2) associated diagnosis categories. RESEARCH DESIGN: This was a retrospective cohort study. SUBJECT: Commercial claims data from the Truven MarketScan database (2014-2018) representing n=846,461,609 outpatient visits. MEASURES: We studied characteristics and utilization of outpatient telemedicine services before the COVID-19 pandemic by patient subgroups based on age, comorbidity burden, residence rurality, and median household income. Disparities were assessed in unadjusted and adjusted (regression) analyses. RESULTS: With overall telemedicine uptake of 0.12% (n=1,018,092/846,461,609 outpatient visits) we found that pre-COVID-19 disparities in telemedicine use became more pronounced over time with lower use in patients who were older, had more comorbidities, were in rural areas, and had lower median household incomes (all trends and effect estimates P<0.001). CONCLUSION: These results contextualize pre-existing disparities in telemedicine use and are crucial in the monitoring of potential disparities in telemedicine access and subsequent outcomes after the rapid expansion of telemedicine during the COVID-19 pandemic.


Subject(s)
Ambulatory Care/trends , COVID-19/therapy , Health Services Accessibility/trends , Healthcare Disparities/statistics & numerical data , Telemedicine/trends , Adult , COVID-19/epidemiology , Humans , Infection Control/trends , Male , Middle Aged , Patient Satisfaction/statistics & numerical data , Quality Improvement , Retrospective Studies
13.
Actas Dermosifiliogr (Engl Ed) ; 112(4): 324-329, 2021 Apr.
Article in English, Spanish | MEDLINE | ID: covidwho-1384815

ABSTRACT

The use and acceptance of teledermatology increased more in the last 2 months of the recent lockdown owing to coronavirus disease 2019 than in the preceding 20 years. This sudden popularity -even among the greatest skeptics- was driven by the need to offer solutions to patients in both public and private settings who suddenly found themselves unable to access in-person dermatological care. Even departments already offering an asynchronous, store-and-forward teledermatology service were obliged to create new systems to support direct interaction between specialists and patients (the direct-to-consumer model). This article suggests some practical ways to implement TD safely and to expedite and optimize teleconsultations; these ideas are not just applicable to a pandemic situation.


Subject(s)
COVID-19 , Dermatology/trends , Skin Diseases , Telemedicine/trends , Humans , Pandemics
18.
Epilepsia ; 62(11): 2732-2740, 2021 11.
Article in English | MEDLINE | ID: covidwho-1379573

ABSTRACT

OBJECTIVE: Health systems make a sizeable contribution to national emissions of greenhouse gases that contribute to global climate change. The UK National Health Service is committed to being a net zero emitter by 2040, and a potential contribution to this target could come from reductions in patient travel. Achieving this will require actions at many levels. We sought to determine potential savings and risks over the short term from telemedicine through virtual clinics. METHODS: During the severe acute respiratory syndrome coronavirus 2 (SARS-2-CoV) pandemic, scheduled face-to-face epilepsy clinics at a specialist site were replaced by remote teleclinics. We used a standard methodology applying conversion factors to calculate emissions based on the total saved travel distance. A further conversion factor was used to derive emissions associated with electricity consumption to deliver remote clinics from which net savings could be calculated. Patients' records and clinicians were interrogated to identify any adverse clinical outcomes. RESULTS: We found that enforced telemedicine delivery for over 1200 patients resulted in the saving of ~224 000 km of travel with likely avoided emissions in the range of 35 000-40 000 kg carbon dioxide equivalent (CO2 e) over a six and half month period. Emissions arising directly from remote delivery were calculated to be <200 kg CO2 e (~0.5% of those for travel), representing a significant net reduction of greenhouse gas emissions. Only one direct adverse outcome was identified, with some additional benefits identified anecdotally. SIGNIFICANCE: The use of telemedicine can make a contribution toward reduced emissions in the health care sector and, in the delivery of specialized epilepsy services, had minimal adverse clinical outcomes over the short term. However, these outcomes will likely vary with clinic locations, medical specialties and conditions.


Subject(s)
COVID-19/epidemiology , Carbon Dioxide/analysis , Delivery of Health Care/trends , Epilepsy/epidemiology , State Medicine/trends , Telemedicine/trends , COVID-19/prevention & control , Epilepsy/therapy , Humans , Travel/trends , United Kingdom/epidemiology
20.
Eur J Gen Pract ; 27(1): 241-247, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1371665

ABSTRACT

BACKGROUND: Telemedicine, once defined merely as the treatment of certain conditions remotely, has now often been supplanted in use by broader terms such as 'virtual care', in recognition of its increasing capability to deliver a diverse range of healthcare services from afar. With the unexpected onset of COVID-19, virtual care (e.g. telephone, video, online) has become essential to facilitating the continuation of primary care globally. Over several short weeks, existing healthcare policies have adapted quickly and empowered clinicians to use digital means to fulfil a wide range of clinical responsibilities, which until then have required face-to-face consultations. OBJECTIVES: This paper aims to explore the virtual care policies and guidance material published during the initial months of the pandemic and examine their potential limitations and impact on transforming the delivery of primary care in high-income countries. METHODS: A rapid review of publicly available national policies guiding the use of virtual care in General Practice was conducted. Documents were included if issued in the first six months of the pandemic (March to August of 2020) and focussed primarily on high-income countries. Documents must have been issued by a national health authority, accreditation body, or professional organisation, and directly refer to the delivery of primary care. RESULTS: We extracted six areas of relevance: primary care transformation during COVID-19, the continued delivery of preventative care, the delivery of acute care, remote triaging, funding & reimbursement, and security standards. CONCLUSION: Virtual care use in primary care saw a transformative change during the pandemic. However, despite the advances in the various governmental guidance offered, much work remains in addressing the shortcomings exposed during COVID-19 and strengthening viable policies to better incorporate novel technologies into the modern primary care clinical environment.


Subject(s)
COVID-19 , Primary Health Care/methods , Telemedicine/methods , Developed Countries , Digital Technology/methods , Health Policy , Humans , Primary Health Care/trends , Telemedicine/trends
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