Telehealth Use to Address Cardiovascular Disease and Hypertension in the United States: A Systematic Review and Meta-Analysis, 2011-2021.

Background: The use of telehealth for the management and treatment of hypertension and cardiovascular disease (CVD) has increased across the United States (U.S.), especially during the COVID-19 pandemic. Telehealth has the potential to reduce barriers to accessing health care and improve clinical outcomes. However, implementation, outcomes, and health equity implications related to these strategies are not well understood. The purpose of this review was to identify how telehealth is being used by U.S. health care professionals and health systems to manage hypertension and CVD and to describe the impact these telehealth strategies have on hypertension and CVD outcomes, with a special focus on social determinants of health and health disparities. Methods: This study comprised a narrative review of the literature and meta-analyses. The meta-analyses included articles with intervention and control groups to examine the impact of telehealth interventions on changes to select patient outcomes, including systolic and diastolic blood pressure. A total of 38 U.S.-based interventions were included in the narrative review, with 14 yielding data eligible for the meta-analyses. Results: The telehealth interventions reviewed were used to treat patients with hypertension, heart failure, and stroke, with most interventions employing a team-based care approach. These interventions utilized the expertise of physicians, nurses, pharmacists, and other health care professionals to collaborate on patient decisions and provide direct care. Among the 38 interventions reviewed, 26 interventions utilized remote patient monitoring (RPM) devices mostly for blood pressure monitoring. Half the interventions used a combination of strategies (e.g., videoconferencing and RPM). Patients using telehealth saw significant improvements in clinical outcomes such as blood pressure control, which were comparable to patients receiving in-person care. In contrast, the outcomes related to hospitalizations were mixed. There were also significant decreases in all-cause mortality when compared to usual care. No study explicitly focused on addressing social determinants of health or health disparities through telehealth for hypertension or CVD. Conclusions: Telehealth appears to be comparable to traditional in-person care for managing blood pressure and CVD and may be seen as a complement to existing care options for some patients. Telehealth can also support team-based care delivery and may benefit patients and health care professionals by increasing opportunities for communication, engagement, and monitoring outside a clinical setting.

Rapid Evaluations of Telehealth Strategies to Address Hypertension: A Mixed-Methods Exploration at Two US Health Systems During the COVID-19 Pandemic.

Telehealth is a promising intervention for hypertension management and control and was rapidly adopted by health systems to ensure continuity of care during the COVID-19 pandemic. Rapid evaluations of telehealth strategies at 2 US health systems explored how telehealth affected health care access and blood pressure outcomes among populations disproportionately affected by hypertension. Both health systems implemented telehealth strategies to maintain continuity of health care services during the COVID-19 pandemic. The evaluations used a mixed-method approach; qualitative interviews were conducted with key staff, and quantitative analyses were performed on patient electronic health record data. Both health systems exhibited similar trends in telehealth use, which allowed for continued access to health care for some patients but hindered other patients who had limited access to the internet or the equipment needed. Telehealth provides opportunities for blood pressure control and management. Further evaluation is needed to understand the role of broadband internet access as a social determinant of health and its impact on equitable patient access to health care.

Impact of Virtual Anatomy on Assessment Outcomes

Many medical schools have transitioned to teaching anatomy with prosections and models1. The efficacy of these curricular approaches as they compare to the gold standard of dissection anatomy has been evaluated2. In addition to helping students acquire professional competencies3, students who participate in dissection achieve higher scores on written examinations than students who participate in prosection1,4. Dissection helps students develop integrated three-dimensional models of the human body, which is fundamental to clinical practice2. In a typical year, medical students at our university take Clinical Morphology which includes histology, embryology, imaging, and dissection anatomy. In 2020, due to the global COVID-19 pandemic, laboratory access was significantly restricted, requiring a shift to a prosection and virtual learning hybrid model. All other components of the course were retained. This necessary change in curriculum provided a natural experiment to investigate the impact of eliminating dissection anatomy on students? academic performance. We hypothesized a negative impact. Students in the 2020 cohort worked in small groups to complete a weekly two-hour online simulated dissection, and attended an optional weekly in-person prosection lab. Faculty-produced prosection videos were available to view asynchronously. Virtual office hours were held in the laboratory. In contrast, the 2019 cohort participated in a traditional dissection anatomy lab that included six hours of instructor-supported dissection each week and 24-hour lab access. All other course components were comparable. Respectively, for the 2020 and 2019 cohorts, mean quiz scores were 86.2 and 85.6;lab practical averages were 92.5 and 86.3;mean NBME scores were 80.9 and 82.2;and course numeric score means were 84.7 and 84.8 (no significant differences, t-test). The frequency of passing and failing scores followed a similar pattern with no differences identified between the two cohorts (Chi Square). All 2020 students had a passing average for lab practicals;significantly better than the 2019 cohort (p < 0.05, Chi Square). Pairwise Pearson r correlation coefficients showed a strong relationship (r > 0.75) for quiz, NBME, and lab practical scores in the 2019 cohort. For the 2020 cohort, there was a strong relationship (r = 0.72) only for quiz and NBME scores. Dissection anatomy correlates strongly with quizzes and the NBME exam performance, while virtual-prosection anatomy does not. The lack of strong pairwise correlations between virtual anatomy with either NBME or quiz performance suggest that the virtual-prosection model did not align well with academic objectives. These data support the continued inclusion of dissection in medical school anatomy. 1. Eppler E, Serowy S, Link K, Filgueira L. Anat Sci Educ. 2018;11:32-43. doi:10.1002/ase.1707 2. Keerti Singh, Uma Gaur, Kiana Hall, Keisha Mascoll, Damian Cohall, Md Anwarul Azim Majumder. Advances in human biology. 2020;10(3):90-94. doi:10.4103/AIHB.AIHB_87_20 3. McDaniel KG, Brown T, Radford CC, et al. Anat Sci Educ. 2020;10.1002/ase.2000. doi:10.1002/ase.2000 4. Thompson AR, Marshall AM. Anat Sci Educ. 2020;13(1):30-36. doi:10.1002/ase.1859