Healthcare Providers' Experience Using Telehealth During the Onset of the COVID-19 Pandemic in a Predominantly Rural Patient Base: An Online Survey.

INTRODUCTION: COVID-19 led to the rapid adoption of telemedicine with a significant spike in the literature concerning the patients' perspective of its use. The providers' perspective has been less well studied. Med Center Health is a healthcare network that provides services in 10 southern Kentucky counties that are home to over 300,000 people with approximately 61% of this population living in areas defined as rural. The goal of this article was to compare the experience of providers serving a predominantly rural population to their patients and compare the experience of providers between each other based on the obtained demographic data. METHODS: An online electronic survey was developed and sent out from July 13th, 2020 to July 27th, 2020 for completion to the 176 physicians of the Med Center Health Physician group. The survey gathered basic demographic information, telemedicine use during COVID-19, and perceptions of telemedicine use during and the role of telemedicine after COVID-19. Perceptions of telemedicine were gauged using Likert and Likert-style questions. Cardiology provider responses were compared to the previously published patient responses. Differences between providers were also analyzed based on the demographic data obtained. RESULTS: Fifty-eight providers responded to the survey with nine providers indicating that they did not use telemedicine during COVID-19. Significant differences between eight cardiologists' and cardiology patients' perceptions of telemedicine visits were seen for internet connectivity (p < 0.001), privacy (p = 0.01), and clinical exam (p < 0.001) with cardiologists ranking these as more concerning or worse in all instances. These results continued when comparing perceptions of patients' in-person experience and providers' perception of telemedicine visits with significant differences observed with clinical exam (p < 0.001), communication (p = 0.048), and overall experience (p = 0.02). No statistically significant differences were seen between cardiologists and other providers. Providers who indicated more than 10 years of practice rated their experience with telemedicine significantly lower in the domains of effective communication (p = 0.004), level of care provided (p = 0.02), thoroughness of clinical exam (p = 0.047), patient comfort discussing concerns (p = 0.04), and overall experience (p = 0.048). Despite this, only three providers indicated that they would not use telemedicine post-pandemic with a majority indicating that they would feel comfortable using telemedicine for follow-up visits and medication refill visits. CONCLUSION: This is the first study to our knowledge to compare patient and provider satisfaction concerning telemedicine across a wide array of topics using Likert-style and Likert scale questions and the first to investigate the perception of providers who serve a predominantly rural patient base during the COVID-19 pandemic. Similar results have been found in a few previous studies concerning telemedicine being less favorably rated by more experienced providers. Further studies need to be conducted to identify and correct the barriers that exist for providers and the adoption of telemedicine.

Angina pain associated with isolated R-IIP modified Lipton classification coronary artery anomaly.

We report a case of a patient that presented with typical angina pain and associated risk factors for coronary artery disease (CAD). Subsequent cardiac catheterisation led to the discovery of an isolated R-IIP modified Lipton classification coronary artery anomaly with follow-up coronary computed tomography angiography (CCTA) confirmation. This case report includes images of the CCTA and left heart catheterisation results, along with a discussion of the potential for increased risk of atherosclerosis in our patient, and a proposed explanation of his presentation with prototypical angina pain, despite lack of apparent atherosclerosis.

Imipramine-Induced Cutaneous and Iris Hyperpigmentation: A Case Report and Literature Review.

Objective: To describe a novel case of imipramine-induced hyperpigmentation and characterize the literature pertaining to imipramine-induced hyperpigmentation to this point.Data Sources: PubMed and Google Scholar were searched through July 2021 utilizing various combinations of imipramine, discoloration, and hyperpigmentation. The references of initial articles were searched for more case reports and imipramine-related literature. Also, articles that cited the references identified in the literature search were reviewed using Google Scholar. Only articles published in English were included.Study Selection: A total of 19 cases of imipramine-induced hyperpigmentation were found in 15 publications to date. All cases were included to determine the variation in clinical presentations of this rare condition.Data Extraction: The case reports were reviewed in their entirety for information concerning patient demographic, clinical presentation, histologic findings on biopsy, and treatment options for imipramine-induced hyperpigmentation.Results: This presentation, to our knowledge, represents the third case of imipramine-induced iris hyperpigmentation, the first case of iris hyperpigmentation occurring in a blue-eyed individual, and the first report to include pictures of the hyperpigmented irides. A novel proposed pathophysiologic mechanism is also provided.Conclusions: Imipramine is a tricyclic antidepressant with a rare side effect of cutaneous and iris hyperpigmentation. Granular dermal deposits in microscopy appear to be the cause of this discoloration. Treatment primarily focuses on discontinuing imipramine or laser therapy.

Coronary Subclavian Steal Syndrome With Neurological Symptoms After Coronary Artery Bypass Grafting.

Coronary subclavian steal syndrome (CSSS) is a complication of coronary artery bypass graft surgery with the left internal mammary artery that results from left subclavian artery stenosis. A reversal of flow in the left internal mammary artery results in ischemia of the heart. We present the case of a 54-year-old man with CSSS with the rare symptom of dizziness. This indicates a potential component of undiagnosed vertebral steal syndrome as well.

Patient Perspectives With Telehealth Visits in Cardiology During COVID-19: Online Patient Survey Study.

BACKGROUND: The rise of COVID-19 and the issue of a mandatory stay-at-home order in March 2020 led to the use of a direct-to-consumer model for cardiology telehealth in Kentucky. Kentucky has poor health outcomes and limited broadband connectivity. Given these and other practice-specific constraints, the region serves as a unique context to explore the efficacy of telehealth in cardiology. OBJECTIVE: This study aims to determine the limitations of telehealth accessibility, patient satisfaction with telehealth relative to in-person visits, and the perceived advantages and disadvantages to telehealth. Our intent was two-fold. First, we wanted to conduct a rapid postassessment of the mandated overhaul of the health care delivery system, focusing on a representative specialty field, and how it was affecting patients. Second, we intend to use our findings to make suggestions about the future application of a telehealth model in specialty fields such as cardiology. METHODS: We constructed an online survey in Qualtrics following the Patient Assessment of Communication During Telemedicine, a patient self-report questionnaire that has been previously developed and validated. We invited all patients who had a visit scheduled during the COVID-19 telehealth-only time frame to participate. Questions included factors for declining telehealth, patient satisfaction ratings of telehealth and in-person visits, and perceived advantages and disadvantages associated with telehealth. We also used electronic medical records to collect no-show data for in-person versus telehealth visits to check for nonresponse bias. RESULTS: A total of 224 respondents began our survey (11% of our sample of 2019 patients). Our recruitment rate was 86% (n=193) and our completion rate was 62% (n=120). The no-show rate for telehealth visits (345/2019, 17%) was nearly identical to the typical no-show rate for in-person appointments. Among the 32 respondents who declined a telehealth visit, 20 (63%) cited not being aware of their appointment as a primary factor, and 15 (47%) respondents cited their opinion that a telehealth appointment was not medically necessary as at least somewhat of a factor in their decision. Both in-person and telehealth were viewed favorably, but in-person was rated higher across all domains of patient satisfaction. The only significantly lower mean score for telehealth (3.7 vs 4.2, P=.007) was in the clinical competence domain. Reduced travel time, lower visit wait time, and cost savings were seen as big advantages. Poor internet connectivity was rated as at least somewhat of a factor by 33.0% (35/106) of respondents. CONCLUSIONS: This study takes advantage of the natural experiment provided by the COVID-19 pandemic to assess the efficacy of telehealth in cardiology. Patterns of satisfaction are consistent across modalities and show that telehealth appears to be a viable alternative to in-person appointments. However, we found evidence that scheduling of telehealth visits may be problematic and needs additional attention. Additionally, we include a note of caution that patient satisfaction with telehealth may be artificially inflated during COVID-19 due to external health concerns connected with in-person visits.