Teaching Telehealth During a Pandemic and Beyond: an Intern's Survival Guide for Virtual Medicine.

BACKGROUND: The rapid transition to telemedicine at the onset of the COVID-19 pandemic required many providers to learn telemedicine "on the fly." As virtual care will likely remain a mainstay of outpatient medicine, it is imperative that telemedicine training be incorporated into graduate medical education. AIM: Design a telemedicine curriculum for internal medicine residents based on principles of experiential learning. SETTING: VA-based internal medicine primary care clinic. PARTICIPANTS: Sixteen first-year internal medicine residents participated in the curriculum. PROGRAM DESCRIPTION: The curriculum included a didactic session followed by four simulated patient encounters focused on troubleshooting technical issues, performing the virtual physical exam, coordinating team-based care, and tackling emergencies. PROGRAM EVALUATION: Participants reported minimal previous experience with telemedicine. After completing the training, resident confidence in conducting video visits increased from an average score of four to seven (on a 10-point scale). Residents were more likely to agree that video visits would allow them to build bonds and effectively address their patients' needs. This increased confidence persisted at 3 months after training. DISCUSSION: Using experiential learning, we identified strategies which increased the confidence of internal medicine trainees in conducting telemedicine visits. Further research is needed to validate our findings across different practice settings.

Factors affecting medication adherence: patient perspectives from five veterans affairs facilities.

BACKGROUND: In the United States, more than 25 million people have diabetes. Medication adherence is known to be important for disease control. However, factors that consistently predict medication adherence are unclear and the literature lacks patient perspectives on how health care systems affect adherence to oral hypoglycemic agents (OHAs). This study explored facilitators and barriers to OHA adherence by obtaining the perspectives of Veterans Affairs (VA) patients with OHA prescriptions. METHODS: A total of 45 patients participated in 12 focus groups that explored a wide range of issues that might affect medication adherence. Participants were patients at clinics in Seattle, Washington; San Antonio, Texas; Portland, Oregon; Salem, Oregon, and Warrenton, Oregon. RESULTS: Key system-level facilitators of OHA adherence included good overall pharmacy service and several specific mechanisms for ordering and delivering medications (automated phone refill service, Web-based prescription ordering), as well as providing pillboxes and printed lists of current medications to patients. Barriers mirrored many of the facilitators. Poor pharmacy service quality and difficulty coordinating multiple prescriptions emerged as key barriers. CONCLUSIONS: VA patient focus groups provided insights on how care delivery systems can encourage diabetes medication adherence by minimizing the barriers and enhancing the facilitators at both the patient and system levels. Major system-level factors that facilitated adherence were overall pharmacy service quality, availability of multiple systems for reordering medications, having a person to call when questions arose, counseling about the importance of adherence and providing tools such as pillboxes and updated medication lists.