The global pandemic spurred a rapid uptake of telehealth for nearly all health care providers and has permanently changed how health care is delivered. At present, providers and insurers are grappling with how to balance telehealth and in person care, focusing discussions around reimbursement models and logistical considerations. In this article, the authors discuss whether telehealth can be considered as good a treatment option as in-person care, if it can be even better, and its potential to address equity in access to care. Many opportunities exist with telehealth, from expanding the provider pool for patients to reducing stigma associated with presenting for in-person care. To ensure these opportunities are realized and result in meaningful improvements in eliminating health disparities, they must be approached strategically. The authors propose several considerations for ensuring equity is at the forefront of telehealth implementation discussions and encourage providers, insurers, and advocates to be purposeful in advancing these opportunities.
{"title":"Getting Beyond Parity: Telehealth as a Best Practice in Health Equity","authors":"Andrew Philip, M. Ford, J. Goldberg","doi":"10.30953/tmt.v7.303","DOIUrl":"https://doi.org/10.30953/tmt.v7.303","url":null,"abstract":"The global pandemic spurred a rapid uptake of telehealth for nearly all health care providers and has permanently changed how health care is delivered. At present, providers and insurers are grappling with how to balance telehealth and in person care, focusing discussions around reimbursement models and logistical considerations. In this article, the authors discuss whether telehealth can be considered as good a treatment option as in-person care, if it can be even better, and its potential to address equity in access to care. Many opportunities exist with telehealth, from expanding the provider pool for patients to reducing stigma associated with presenting for in-person care. To ensure these opportunities are realized and result in meaningful improvements in eliminating health disparities, they must be approached strategically. The authors propose several considerations for ensuring equity is at the forefront of telehealth implementation discussions and encourage providers, insurers, and advocates to be purposeful in advancing these opportunities. ","PeriodicalId":320236,"journal":{"name":"Telehealth and Medicine Today","volume":"75 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125667092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rehabilitation is a major component of health sciences, and is the process of restoring an incapacitated individual to a normal life through training and therapy. Globally, 2.4 billion people may currently require rehabilitation. In 60 to 70% of countries, existing rehabilitation services have been disrupted due to the coronavirus disease 2019 (COVID-19) pandemic. Even after lockdowns and with vaccinations, some form of physical distancing is likely to be part of the new normal. Concurrently, there is an exponential growth of telehealth. This global overview will demonstrate that telerehabilitation (TR) is likely to be a distinct stand-alone sub-specialty of telehealth. Details of setting up TR, methods, and components are discussed, and clinical indications, limitations, advantages, disadvantages, challenges, and barriers to implementation and technological advances in TR are highlighted followed by an in-depth study of the literature from India.
{"title":"Telerehabilitation: An Overview","authors":"Ganapathy Krishnan","doi":"10.30953/tmt.v6.285","DOIUrl":"https://doi.org/10.30953/tmt.v6.285","url":null,"abstract":"Rehabilitation is a major component of health sciences, and is the process of restoring an incapacitated individual to a normal life through training and therapy. Globally, 2.4 billion people may currently require rehabilitation. In 60 to 70% of countries, existing rehabilitation services have been disrupted due to the coronavirus disease 2019 (COVID-19) pandemic. Even after lockdowns and with vaccinations, some form of physical distancing is likely to be part of the new normal. Concurrently, there is an exponential growth of telehealth. This global overview will demonstrate that telerehabilitation (TR) is likely to be a distinct stand-alone sub-specialty of telehealth. Details of setting up TR, methods, and components are discussed, and clinical indications, limitations, advantages, disadvantages, challenges, and barriers to implementation and technological advances in TR are highlighted followed by an in-depth study of the literature from India.","PeriodicalId":320236,"journal":{"name":"Telehealth and Medicine Today","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124956970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction - The COVID 19 pandemic led to restrictions on the conventional ways of healthcare delivery. Telemedicine provided a viable solution that was in line with the social distancing policies imposed to minimize disease transmission. This demanded physicians adapt to new ways of healthcare delivery. We surveyed geneticists across the country to determine their experience and to ascertain if telegenetics will be a lasting change. Materials and Methods - A 23 item standardized survey was distributed to various US-based geneticists via email and other social media platforms focusing on their experience of providing care via telemedicine. Results - We received 69 responses from physicians across 26 states. Of these, 91% practiced in academia. 70% responded that pediatric genetics takes up more than 50% of their practice. 68% had over 50% of their practice switch to telemedicine. 77% felt they could provide adequate care via telemedicine and 94% of providers would like to continue telemedicine post-pandemic. Conclusion - The future of telemedicine looks promising as the majority of clinicians would like to routinely use telemedicine post-pandemic. Uniform guidelines for use of telemedicine in genetics may need to be proposed by professional societies and supported by federal laws.
{"title":"Telegenetics and COVID 19: Through the Pandemic and Beyond","authors":"Soumiya Ravi, Aaina Kochhar, R. Dhamija","doi":"10.30953/tmt.v6.295","DOIUrl":"https://doi.org/10.30953/tmt.v6.295","url":null,"abstract":"Introduction - The COVID 19 pandemic led to restrictions on the conventional ways of healthcare delivery. Telemedicine provided a viable solution that was in line with the social distancing policies imposed to minimize disease transmission. This demanded physicians adapt to new ways of healthcare delivery. We surveyed geneticists across the country to determine their experience and to ascertain if telegenetics will be a lasting change. \u0000Materials and Methods - A 23 item standardized survey was distributed to various US-based geneticists via email and other social media platforms focusing on their experience of providing care via telemedicine. \u0000Results - We received 69 responses from physicians across 26 states. Of these, 91% practiced in academia. 70% responded that pediatric genetics takes up more than 50% of their practice. 68% had over 50% of their practice switch to telemedicine. 77% felt they could provide adequate care via telemedicine and 94% of providers would like to continue telemedicine post-pandemic. \u0000Conclusion - The future of telemedicine looks promising as the majority of clinicians would like to routinely use telemedicine post-pandemic. Uniform guidelines for use of telemedicine in genetics may need to be proposed by professional societies and supported by federal laws. ","PeriodicalId":320236,"journal":{"name":"Telehealth and Medicine Today","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131290011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
As telehealth is increasingly adopted across all care settings, it is important to understand how clinicians can adapt and respond to patient needs. Drawing from experiences of a virtual primary care physician and a patient advocate, this Perspectives editorial provides additional insights beyonds the telehealth basics for establishing digital empathy and a remote therapeutic connection.
{"title":"Enhancing Digital Empathy and Reimagining the Telehealth Experience","authors":"Matthew Sakumoto, Sarah Krug","doi":"10.30953/tmt.v6.304","DOIUrl":"https://doi.org/10.30953/tmt.v6.304","url":null,"abstract":"As telehealth is increasingly adopted across all care settings, it is important to understand how clinicians can adapt and respond to patient needs. Drawing from experiences of a virtual primary care physician and a patient advocate, this Perspectives editorial provides additional insights beyonds the telehealth basics for establishing digital empathy and a remote therapeutic connection.","PeriodicalId":320236,"journal":{"name":"Telehealth and Medicine Today","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128379467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In the age of digitization, telemedicine services are utilized more than ever, and this trend affects healthcare as well. Although the utilization of technology serves as a benefit in allowing more access to care, COVID-19 has identified some of the weaknesses and discrepancies of the system. The increase in usage of technology has shed light on and increased the severity of the gaps in the regulatory and legal infrastructure overseeing this rapid growth. We aim to evaluate the strengths and weaknesses of the telemedicine healthcare system, as well as address the frequent misconduct that occurs between patients and their nurses, pharmacists, and physician assistants, in order to highlight the necessity of a standardized method of reporting misconduct on an international, national, state, county, and local level. Our findings should alert the healthcare community of the growing urgency to address the policy and regulatory aspects of telemedicine to provide greater quality and safety during the post-COVID era.
{"title":"Enhancing Quality of Healthcare and Patient Safety: Oversight of Physician Assistants, Nurses, and Pharmacists in Era of COVID-19 and Beyond","authors":"Lauren W Park, Dr. Amar Gupta","doi":"10.30953/tmt.v6.298","DOIUrl":"https://doi.org/10.30953/tmt.v6.298","url":null,"abstract":"In the age of digitization, telemedicine services are utilized more than ever, and this trend affects healthcare as well. Although the utilization of technology serves as a benefit in allowing more access to care, COVID-19 has identified some of the weaknesses and discrepancies of the system. The increase in usage of technology has shed light on and increased the severity of the gaps in the regulatory and legal infrastructure overseeing this rapid growth. We aim to evaluate the strengths and weaknesses of the telemedicine healthcare system, as well as address the frequent misconduct that occurs between patients and their nurses, pharmacists, and physician assistants, in order to highlight the necessity of a standardized method of reporting misconduct on an international, national, state, county, and local level. Our findings should alert the healthcare community of the growing urgency to address the policy and regulatory aspects of telemedicine to provide greater quality and safety during the post-COVID era. ","PeriodicalId":320236,"journal":{"name":"Telehealth and Medicine Today","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114341310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: To validate an algorithm previously developed by the Healthcare Technology Innovation Centre, IIT Madras, India for screening of diabetic retinopathy (DR), in fundus images of diabetic patients from telecamps to examine the screening performance for DR. Design: Photographs of patients with diabetes were examined using the automated algorithm for the detection of DR Setting: Mobile Teleophthalmology camps were conducted in two districts in Tamil Nadu, India from Jan 2015 to May 2017. Participants: 939 eyes of 472 diabetic patients were examined at Mobile Teleophthalmology camps in Thiruvallur and Kanchipuram districts, Tamil Nadu, India,. Fundus images were obtained (40-45-degree posterior pole in each eye) for all patients using a nonmydriatic fundus camera by the fundus photographer. Main Outcome Measures: Fundus images were evaluated for presence or absence of DR using a computer-assisted algorithm, by an ophthalmologist at a tertiary eye care centre (reference standard) and by a fundus photographer. Results: The algorithm demonstrated 85% sensitivity and 80% specificity in detecting DR compared to ophthalmologist. The area under the receiver operating characteristic curve was 0.69 (95%CI=0.65 to 0.73). The algorithm identified 100% of vision-threatening retinopathy just like the ophthalmologist. When compared to the photographer, the algorithm demonstrated 81% sensitivity and 78% specificity. The sensitivity of the photographer to detect DR was found to be 86% and specificity was 99% in detecting DR compared to ophthalmologist. Conclusions: The algorithm can detect the presence or absence of DR in diabetic patients. All findings of vision-threatening retinopathy could be detected with reasonable accuracy and will help to reduce the workload for human graders in remote areas.
{"title":"Validation of Computer-Aided Diagnosis of Diabetic Retinopathy from Retinal Photographs of Diabetic Patients from Telecamps","authors":"S. John, S. Srinivasan, Natarajan Sundaram","doi":"10.30953/tmt.v6.300","DOIUrl":"https://doi.org/10.30953/tmt.v6.300","url":null,"abstract":"Objective: To validate an algorithm previously developed by the Healthcare Technology Innovation Centre, IIT Madras, India for screening of diabetic retinopathy (DR), in fundus images of diabetic patients from telecamps to examine the screening performance for DR.\u0000Design: Photographs of patients with diabetes were examined using the automated algorithm for the detection of DR \u0000Setting: Mobile Teleophthalmology camps were conducted in two districts in Tamil Nadu, India from Jan 2015 to May 2017.\u0000Participants: 939 eyes of 472 diabetic patients were examined at Mobile Teleophthalmology camps in Thiruvallur and Kanchipuram districts, Tamil Nadu, India,. Fundus images were obtained (40-45-degree posterior pole in each eye) for all patients using a nonmydriatic fundus camera by the fundus photographer.\u0000Main Outcome Measures: Fundus images were evaluated for presence or absence of DR using a computer-assisted algorithm, by an ophthalmologist at a tertiary eye care centre (reference standard) and by a fundus photographer.\u0000Results: The algorithm demonstrated 85% sensitivity and 80% specificity in detecting DR compared to ophthalmologist. The area under the receiver operating characteristic curve was 0.69 (95%CI=0.65 to 0.73). The algorithm identified 100% of vision-threatening retinopathy just like the ophthalmologist. When compared to the photographer, the algorithm demonstrated 81% sensitivity and 78% specificity. The sensitivity of the photographer to detect DR was found to be 86% and specificity was 99% in detecting DR compared to ophthalmologist.\u0000Conclusions: The algorithm can detect the presence or absence of DR in diabetic patients. All findings of vision-threatening retinopathy could be detected with reasonable accuracy and will help to reduce the workload for human graders in remote areas.","PeriodicalId":320236,"journal":{"name":"Telehealth and Medicine Today","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116309471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
As we look towards post-pandemic health delivery, the role of telehealth must be examined. We use the RE-AIM framework to discuss the challenges and successes of telehealth during the pandemic in the United States, and propose critical aspects to consider for optimizing telehealth care in the future.
{"title":"Telehealth in the Post Pandemic Era","authors":"A. Cahill, E. Matsui","doi":"10.30953/tmt.v6.291","DOIUrl":"https://doi.org/10.30953/tmt.v6.291","url":null,"abstract":"As we look towards post-pandemic health delivery, the role of telehealth must be examined. We use the RE-AIM framework to discuss the challenges and successes of telehealth during the pandemic in the United States, and propose critical aspects to consider for optimizing telehealth care in the future.","PeriodicalId":320236,"journal":{"name":"Telehealth and Medicine Today","volume":"295 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134426174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives: Like other areas of care affected by the COVID-19 pandemic, telehealth (both audio and video) was rapidly adopted in the obstetric setting. We performed a retrospective analysis of electronic health record (EHR) data to characterize the sociodemographic and clinical factors associated with telehealth utilization among patients who received prenatal care. Materials and Methods: The study period covered March 23rd, 2020 to July 2nd, 2020, during which time 2,521 patients received prenatal care at a large academic medical center. We applied a generalized logistic regression to measure the relationship between the patients’ sociodemographic factors (in terms of age, race, ethnicity, urbanization level, and insurance type), pregnancy complications (namely, type 2 diabetes, chronic hypertension, and fetal growth restriction), and telehealth usage, as documented in the EHR. Results: During the study period, 2,521 patients had 16,516 prenatal care visits. 938 (37.2%) of the patients participated in at least one of 1,934 virtual prenatal care visits. Prenatal visits were more likely to be conducted through telehealth for patients who were older than 25 years old and lived in rural areas. In addition, patients who were with type 2 diabetes were more likely to use telehealth in their prenatal care (adjusted Odds Ratio (aOR) 7.247 [95% Confidence Interval (95% CI) 4.244 – 12.933]). By contrast, patients from racial and ethnic minority groups were less likely to have a telehealth encounter compared to white or non-Hispanic patients (aOR 0.603 [95% CI 0.465 – 0.778] and aOR 0.663 [95% CI 0.471 – 0.927], respectively). Additionally, patients who were on state-level Medicaid were less likely to use telehealth (aOR 0.495 [95% CI 0.402 – 0.608]). Discussion: Disparities in telehealth use for prenatal care suggest further investigations into access barriers. Hispanic patients who had low English language proficiency may not willing to see doctors via virtual care. Availability of high-speed internet and/or hardware may hold these patients who were insured through state-level Medicaid back due to poverty. Future work is advised to minimize access barriers to telehealth in its implementation. Conclusions: While telehealth expanded prenatal care access for childbearing women during the COVID-19 pandemic, this study suggested that there were non-trivial differences in the demographics of patients who utilized such settings.
目标:与受COVID-19大流行影响的其他护理领域一样，产科环境迅速采用了远程医疗(音频和视频)。我们对电子健康记录(EHR)数据进行了回顾性分析，以表征接受产前护理的患者中与远程医疗利用相关的社会人口统计学和临床因素。材料与方法:研究时间为2020年3月23日至2020年7月2日，2521例患者在某大型学术医疗中心接受产前护理。我们应用广义逻辑回归来衡量患者的社会人口因素(年龄、种族、民族、城市化水平和保险类型)、妊娠并发症(即2型糖尿病、慢性高血压和胎儿生长受限)和远程医疗使用之间的关系，这些都记录在电子病历中。结果:在研究期间，2521名患者进行了16516次产前护理。938名(37.2%)患者至少参加了1934次虚拟产前护理访问中的一次。25岁以上、居住在农村地区的患者更有可能通过远程保健进行产前检查。此外，2型糖尿病患者更倾向于在产前护理中使用远程医疗(调整优势比(aOR) 7.247[95%可信区间(95% CI) 4.244 - 12.933])。相比之下，与白人或非西班牙裔患者相比，种族和少数民族患者更不可能有远程医疗就诊(aOR分别为0.603 [95% CI 0.465 - 0.778]和0.663 [95% CI 0.471 - 0.927])。此外，接受州级医疗补助的患者更不可能使用远程医疗(比值比0.495 [95% CI 0.402 - 0.608])。讨论:远程保健用于产前护理的差异建议进一步调查获取障碍。英语水平较低的西班牙裔患者可能不愿意通过虚拟护理去看医生。高速互联网和/或硬件的可用性可能会使这些通过州一级医疗补助计划获得保险的患者因贫困而退缩。建议今后的工作在实施过程中尽量减少获取远程保健的障碍。结论:虽然远程医疗在COVID-19大流行期间扩大了育龄妇女的产前护理机会，但本研究表明，利用这种环境的患者的人口统计数据存在重大差异。
{"title":"Prenatal Telehealth During the Pandemic: Sociodemographic and Clinical Associations","authors":"Cheng Gao, S. Osmundson, B. Malin, You Chen","doi":"10.30953/tmt.v6.279","DOIUrl":"https://doi.org/10.30953/tmt.v6.279","url":null,"abstract":"Objectives: Like other areas of care affected by the COVID-19 pandemic, telehealth (both audio and video) was rapidly adopted in the obstetric setting. We performed a retrospective analysis of electronic health record (EHR) data to characterize the sociodemographic and clinical factors associated with telehealth utilization among patients who received prenatal care. \u0000Materials and Methods: The study period covered March 23rd, 2020 to July 2nd, 2020, during which time 2,521 patients received prenatal care at a large academic medical center. We applied a generalized logistic regression to measure the relationship between the patients’ sociodemographic factors (in terms of age, race, ethnicity, urbanization level, and insurance type), pregnancy complications (namely, type 2 diabetes, chronic hypertension, and fetal growth restriction), and telehealth usage, as documented in the EHR. \u0000Results: During the study period, 2,521 patients had 16,516 prenatal care visits. 938 (37.2%) of the patients participated in at least one of 1,934 virtual prenatal care visits. Prenatal visits were more likely to be conducted through telehealth for patients who were older than 25 years old and lived in rural areas. In addition, patients who were with type 2 diabetes were more likely to use telehealth in their prenatal care (adjusted Odds Ratio (aOR) 7.247 [95% Confidence Interval (95% CI) 4.244 – 12.933]). By contrast, patients from racial and ethnic minority groups were less likely to have a telehealth encounter compared to white or non-Hispanic patients (aOR 0.603 [95% CI 0.465 – 0.778] and aOR 0.663 [95% CI 0.471 – 0.927], respectively). Additionally, patients who were on state-level Medicaid were less likely to use telehealth (aOR 0.495 [95% CI 0.402 – 0.608]). \u0000Discussion: Disparities in telehealth use for prenatal care suggest further investigations into access barriers. Hispanic patients who had low English language proficiency may not willing to see doctors via virtual care. Availability of high-speed internet and/or hardware may hold these patients who were insured through state-level Medicaid back due to poverty. Future work is advised to minimize access barriers to telehealth in its implementation. \u0000Conclusions: While telehealth expanded prenatal care access for childbearing women during the COVID-19 pandemic, this study suggested that there were non-trivial differences in the demographics of patients who utilized such settings.","PeriodicalId":320236,"journal":{"name":"Telehealth and Medicine Today","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126114268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
ABSTRACT The COVID-19 pandemic led to temporary relaxations for telehealth with respect to physician licensure, geographic location, and eligible sites for reimbursement. Earlier policies had impacted the rate of adoption of telehealth and retarded the ability to derive full benefits related to cost, access to care, and quality of care. This aspect is analyzed using 2018 Medicare fee-for-service codes and rates for 10 telemedicine services. Based on the analysis of these data, additional research, and literature review, this report describes how interstate practices can be better leveraged to achieve maximum potential for direct and indirect savings that can accrue through such pragmatic approaches for certain services. The interstate collaborations proposed in this report provide examples of broader telehealth policies that could foster increasing access to quality health care for Medicare beneficiaries and can potentially be used as insight to assist federal and state agencies as they review the continuation, cessation, or modifications of relaxations granted due to the COVID-19 pandemic.
{"title":"Medicare Telehealth Pre and Post-COVID-19","authors":"Sophia Albanese, Amar Gupta, Ilina Shah, J. Mitri","doi":"10.30953/tmt.v6.299","DOIUrl":"https://doi.org/10.30953/tmt.v6.299","url":null,"abstract":"ABSTRACT \u0000The COVID-19 pandemic led to temporary relaxations for telehealth with respect to physician licensure, geographic location, and eligible sites for reimbursement. Earlier policies had impacted the rate of adoption of telehealth and retarded the ability to derive full benefits related to cost, access to care, and quality of care. This aspect is analyzed using 2018 Medicare fee-for-service codes and rates for 10 telemedicine services. Based on the analysis of these data, additional research, and literature review, this report describes how interstate practices can be better leveraged to achieve maximum potential for direct and indirect savings that can accrue through such pragmatic approaches for certain services. The interstate collaborations proposed in this report provide examples of broader telehealth policies that could foster increasing access to quality health care for Medicare beneficiaries and can potentially be used as insight to assist federal and state agencies as they review the continuation, cessation, or modifications of relaxations granted due to the COVID-19 pandemic.","PeriodicalId":320236,"journal":{"name":"Telehealth and Medicine Today","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117146079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. McCune, James Pellegrin, Anshul Sachdeva, Roxana Cham, Jessica Sollaccio, Sandra Giramahoro Coyne, M. Stewart
Objective: Reducing antibiotic overuse is a point of emphasis of the Centers for Disease Control and Prevention (CDC). Despite this, both telemedicine and traditional in-person medical care struggle to meet national guidelines. This study evaluates antibiotic prescribing practices at 98point6, a Seattle-based provider of virtual primary care. This paper reviews a novel combination of machine learning with a physician-led virtual platform and smartphone interface to exceed published benchmarks for the avoidance of antibiotics in the treatment of bronchitis. Design: This retrospective cohort study looks at patients ages 18–64 who presented to 98point6 with “acute bronchitis/bronchiolitis” diagnosed between December 1, 2019 and November 30, 2020. Visits were categorized by whether systemic antibiotics were or were not given. Cases in which systemic antibiotics were given were categorized as “broad spectrum” or “narrow spectrum”. The results are presented as descriptive statistics with demographic information and compared to published reports of antibiotic use for the treatment of bronchitis. Results: Of the 1,238 visits with a bronchitis/bronchiolitis diagnosis, 99 (8.0%) were treated with prescribed systemic antibiotics. The rate of antibiotic avoidance of 92.0% compares favorably with published benchmarks from the National Committee for Quality Assurance and is significantly lower than rates in previously published samples for telemedicine, primary care and urgent care. Conclusion: Virtual primary care administered by 98point6 resulted in a high rate of adherence to the established standard for the treatment of bronchitis, greatly exceeding benchmarks and published results from both telemedicine and in-person medical practice.
{"title":"Reducing Unnecessary Antibiotic Treatment for Acute Bronchitis Using Virtual Primary Care","authors":"D. McCune, James Pellegrin, Anshul Sachdeva, Roxana Cham, Jessica Sollaccio, Sandra Giramahoro Coyne, M. Stewart","doi":"10.30953/tmt.v6.272","DOIUrl":"https://doi.org/10.30953/tmt.v6.272","url":null,"abstract":"Objective: Reducing antibiotic overuse is a point of emphasis of the Centers for Disease \u0000Control and Prevention (CDC). Despite this, both telemedicine and traditional in-person \u0000medical care struggle to meet national guidelines. This study evaluates antibiotic \u0000prescribing practices at 98point6, a Seattle-based provider of virtual primary care. This \u0000paper reviews a novel combination of machine learning with a physician-led virtual \u0000platform and smartphone interface to exceed published benchmarks for the avoidance \u0000of antibiotics in the treatment of bronchitis. \u0000 \u0000Design: This retrospective cohort study looks at patients ages 18–64 who presented to \u000098point6 with “acute bronchitis/bronchiolitis” diagnosed between December 1, 2019 \u0000and November 30, 2020. Visits were categorized by whether systemic antibiotics were \u0000or were not given. Cases in which systemic antibiotics were given were categorized as \u0000“broad spectrum” or “narrow spectrum”. The results are presented as descriptive \u0000statistics with demographic information and compared to published reports of \u0000antibiotic use for the treatment of bronchitis. \u0000 \u0000Results: Of the 1,238 visits with a bronchitis/bronchiolitis diagnosis, 99 (8.0%) were \u0000treated with prescribed systemic antibiotics. The rate of antibiotic avoidance of 92.0% \u0000compares favorably with published benchmarks from the National Committee for \u0000Quality Assurance and is significantly lower than rates in previously published samples \u0000for telemedicine, primary care and urgent care. \u0000 \u0000Conclusion: Virtual primary care administered by 98point6 resulted in a high rate of \u0000adherence to the established standard for the treatment of bronchitis, greatly exceeding \u0000benchmarks and published results from both telemedicine and in-person medical \u0000practice.","PeriodicalId":320236,"journal":{"name":"Telehealth and Medicine Today","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129504909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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