RESUMEN
Telehealth services, specifically telemedicine audio-video and audio-only patient encounters, expanded dramatically during the COVID-19 pandemic through temporary waivers and flexibilities tied to the public health emergency. Early studies demonstrate significant potential to advance the quintuple aim (patient experience, health outcomes, cost, clinician well-being, and equity). Supported well, telemedicine can particularly improve patient satisfaction, health outcomes, and equity. Implemented poorly, telemedicine can facilitate unsafe care, worsen disparities, and waste resources. Without further action from lawmakers and agencies, payment will end for many telemedicine services currently used by millions of Americans at the end of 2024. Policymakers, health systems, clinicians, and educators must decide how to support, implement, and sustain telemedicine, and long-term studies and clinical practice guidelines are emerging to provide direction. In this position statement, we use clinical vignettes to review relevant literature and highlight where key actions are needed. These include areas where telemedicine must be expanded (e.g., to support chronic disease management) and where guidelines are needed (e.g., to prevent inequitable offering of telemedicine services and prevent unsafe or low-value care). We provide policy, clinical practice, and education recommendations for telemedicine on behalf of the Society of General Internal Medicine. Policy recommendations include ending geographic and site restrictions, expanding the definition of telemedicine to include audio-only services, establishing appropriate telemedicine service codes, and expanding broadband access to all Americans. Clinical practice recommendations include ensuring appropriate telemedicine use (for limited acute care situations or in conjunction with in-person services to extend longitudinal care relationships), that the choice of modality be done through patient-clinician shared decision-making, and that health systems design telemedicine services through community partnerships to ensure equitable implementation. Education recommendations include developing telemedicine-specific educational strategies for trainees that align with accreditation body competencies and providing educators with protected time and faculty development resources.
RESUMEN
The Georgia Food for Health program (GF4H) is a clinic-based nutrition education and food security intervention program that has demonstrated the ability to improve dietary behaviors. However, little is known about changes in behaviors during COVID-related lockdowns.To characterize diet behavior changes experienced by former participants of a food security intervention during COVID-related lockdowns.We conducted semi-structured interviews by phone with 17 patient participants in May - June 2020 with program participants who had completed the program within the past 6 months. Participants were asked questions about the program, diet and stress-related behaviors, and changes in these behaviors within the COVID lockdown period.Participants were mainly middle-aged (mean age 59 years), African American (100%), women (59%). Approximately half screened positive for food insecurity (47.1%). All participants were healthy at the time of the interview.Transcripts of interviews were analyzed for both apriori and emergent themes using thematic analysis.We identified 3 central themes. First, participants discussed changes in shopping behaviors to minimize time spent in stores using approaches like shopping lists to plan routes within the store or sending younger relatives to shop for them. Due to supply issues at stores, participants discussed adapting recipes to include available options. Second, participants discussed disinterest in cooking, a lack of motivation to engage in healthy eating strategies they had previously adopted, and anticipation of regretting these behaviors post-COVID. Third, participants were largely uncomfortable at the prospect of resuming in-person programming and preferred virtual options due to safety concerns.Among former participants of the GF4H program, shopping and cooking behaviors shifted during the COVID-19 lockdown period to adapt to safety guidelines and to overcome supply issues. Motivation to engage in healthy cooking and eating behaviors was diminished. Ongoing program efforts should focus on virtual options to engage and re-engage participants.
RESUMEN
As members of the Clinical Practice Committee (CPC) of the Society for General Internal Medicine (SGIM), we support practice innovation and transformation to achieve a more just system by which all people can achieve and maintain optimal health. The COVID-19 pandemic has tested the US healthcare delivery system and sharpened our national awareness of long-standing and ingrained system shortcomings. In the face of crisis, SGIM members innovated and energetically mobilized to focus on the immediate needs of our patients and communities. Reflecting on these experiences, we are called to consider what was learned from the pandemic that applies to the future of healthcare delivery. CPC members include leaders in primary care delivery, practice finance, quality of care, patient safety, hospital practice, and health policy. CPC members provide expertise in clinical practice, serving as primary care doctors, hospitalists, and patient advocates who understand the intensity of care needed for those with severe COVID-19 infections, the disproportionate impact of the pandemic on Black and Brown communities, the struggles created for those with poor access to care, and the physical and emotional impact it has placed on patients, families, and clinicians. In this consensus statement, we summarize lessons learned from the 2020-2021 pandemic and their broader implications for reform in healthcare delivery. We provide a platform for future work by identifying many interactive elements of healthcare delivery that must be simultaneously addressed in order to ensure that care is accessible, equitably provided, patient-centered, and cost-effective.