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1.
Otolaryngol Clin North Am ; 55(1): 145-151, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34823713

RESUMO

A perfect storm of events to include the COVID-19 global pandemic and technologic advances has led to the emergence of telemedicine in otolaryngology as a means to deliver remote clinical services to patients in their home and other clinical settings. There are benefits, such as increased safety and increased access to care, but also challenges, such as need for advanced technology and familiarity with computers. Telemedicine could play a greater role in otolaryngology in the future with advances in smartphone and endoscopic technology allowing for more detailed examination of patients.


Assuntos
COVID-19 , Otolaringologia , Telemedicina , Humanos , Recompensa , SARS-CoV-2
2.
J Public Health Manag Pract ; 28(1): 77-85, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34654021

RESUMO

CONTEXT: During the COVID-19 pandemic, demand for telehealth services increased to reduce disease exposure for patients and providers and to meet preexisting demand for physician services in health resource shortage areas. OBJECTIVE: To estimate self-reported telehealth availability, equipment for accessing telehealth, and telehealth usage among Medicare beneficiaries during the COVID-19 pandemic. DESIGN: We used data from the 2020 Medicare Current Beneficiary Survey (MCBS) COVID-19 Fall Supplement Public Use File to estimate the weighted percentages of beneficiaries who had (a) access to telehealth before or during COVID-19; (b) equipment for accessing telehealth; and (c) telehealth visits during COVID-19. We used logistic regression to examine sociodemographic factors associated with telehealth usage. PARTICIPANTS: Beneficiaries who participated in the MCBS COVID-19 Fall Supplements. RESULTS: During October and November 2020, telehealth appointments offered by providers were available to 63.8% (95% confidence interval [CI], 61.8-65.9) of Medicare beneficiaries who had accessed medical care by telephone or video. Among those, only 18.0% (95% CI, 16.1-19.9) had been offered telehealth before the pandemic. The majority of beneficiaries (92.2%; 95% CI, 91.2-93.1) had 1 or more types of equipment available for accessing telehealth, but only 44.9% (95% CI, 43.0-46.9) had had a telehealth visit since July 1, 2020. Older adults, minorities, those with a lower income, and non-English speakers had less availability of telehealth equipment. Patient characteristics were significantly (P < .05) associated with telehealth use, including age, sex, race/ethnicity, and equipment availability. CONCLUSION: Telehealth availability for Medicare beneficiaries increased substantially during the COVID-19 pandemic. Even with the improvement in telehealth offerings and use hastened by the pandemic, gaps in access and use still exist. Effectiveness and implementation research can find ways to close gaps in telehealth services between vulnerable and underrepresented populations and counterparts.


Assuntos
COVID-19 , Telemedicina , Idoso , Humanos , Medicare , Pandemias/prevenção & controle , SARS-CoV-2 , Estados Unidos
3.
J Nurs Care Qual ; 37(1): 47-53, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34224534

RESUMO

BACKGROUND: Influenza vaccinations are a preventive health quality measure. Home telehealth nursing staff interventions can reduce influenza disease burden and complications. PURPOSE: To improve seasonal flu vaccine rates using novel home telehealth clinical and technology interventions. METHODS: A pre- and postintervention concurrent cohort study for 513 outpatients was conducted. Interventions included automated 2-way patient messaging using remote monitoring equipment, a new note template to record vaccination status in the electronic health record, and flu vaccine patient education. RESULTS: Interventions resulted in vaccination rates of 70.4% for Veterans ages 19 to 65 years, and 81.7% for Veterans 66 years and older, exceeding national, regional, and local Veterans Administration targets. CONCLUSIONS: Two-way messaging and standardized documentation increased rates. Declinations persisted despite education. Reasons included fear of side effects, and rarely leaving home due to the COVID-19 pandemic. Nursing interventions can increase influenza vaccination quality measures for primary care home telehealth patients.


Assuntos
COVID-19 , Influenza Humana , Telemedicina , Adulto , Idoso , Estudos de Coortes , Humanos , Influenza Humana/epidemiologia , Influenza Humana/prevenção & controle , Pessoa de Meia-Idade , Pandemias , Indicadores de Qualidade em Assistência à Saúde , SARS-CoV-2 , Vacinação , Adulto Jovem
4.
J Med Syst ; 45(12): 107, 2021 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-34735603

RESUMO

Healthcare professionals in healthcare systems need access to freely available, real-time, evidence-based mortality risk prediction smartphone applications to facilitate resource allocation. The objective of this study is to evaluate the quality of smartphone mobile health applications that include mortality prediction models, and corresponding information quality. We conducted a systematic review of commercially available smartphone applications in Google Play for Android, and iTunes for iOS smartphone applications. We performed initial screening, data extraction, and rated smartphone application quality using the Mobile Application Rating Scale: user version (uMARS). The information quality of smartphone applications was evaluated using two patient vignettes, representing low and high risk of mortality, based on critical care data from the Medical Information Mart for Intensive Care (MIMIC) III database. Out of 3051 evaluated smartphone applications, 33 met our final inclusion criteria. We identified 21 discrete mortality risk prediction models in smartphone applications. The most common mortality predicting models were Sequential Organ Failure Assessment (SOFA) (n = 15) and Acute Physiology and Clinical Health Assessment II (n = 13). The smartphone applications with the highest quality uMARS scores were Observation-NEWS 2 (4.64) for iOS smartphones, and MDCalc Medical Calculator (4.75) for Android smartphones. All SOFA-based smartphone applications provided consistent information quality with the original SOFA model for both the low and high-risk patient vignettes. We identified freely available, high-quality mortality risk prediction smartphone applications that can be used by healthcare professionals to make evidence-based decisions in critical care environments.


Assuntos
Aplicativos Móveis , Telemedicina , Atenção à Saúde , Pessoal de Saúde , Humanos , Smartphone
5.
Addict Sci Clin Pract ; 16(1): 66, 2021 11 10.
Artigo em Inglês | MEDLINE | ID: mdl-34758881

RESUMO

BACKGROUND: The emergency department (ED) offers an important opportunity to identify patients with opioid use disorder (OUD) and initiate treatment. However, post-ED follow-up is challenging, and novel approaches to enhance care transitions are urgently needed. Outcomes following ED visits have traditionally focused on overdose, treatment engagement, and mortality with an absence of patient reported outcomes (PROs), for example patient ability to schedule follow-up OUD treatment appointments or pick up a prescription medication, that may better inform evaluation of treatment pathways and near-term outcomes after acute events. In the context of increasing novel secure mobile health (mHealth) platforms, we explored the feasibility and acceptability of electronically collecting PROs from ED patients with non-medical opioid use to enhance care in the ED and transitions of care. METHODS: ED patients with non-medical opioid use or opioid overdose who endorsed willingness and ability to complete electronic surveys after discharge were enrolled from a tertiary, urban academic ED. Participants were enrolled in an mHealth platform, shared electronic health records with researchers, and completed electronic surveys of PROs at baseline, three- and thirty-days post discharge from the hospital, including questions about ability to schedule a follow-up appointment, pick up a prescription medication and overdose risk behaviors. Primary outcomes were measures of feasibility and acceptability of electronic PRO collection among ED patients with non-medical opioid use. RESULTS: Among 1,808 patients assessed for eligibility between June-December 2019, 101 of 130 (78%) eligible adult patients consented to participate. Ninety-six (95%) of 101 patients completed registration in the mHealth platform, and 77/96 (80%) were successful in sharing their electronic health data. Completion rates for the baseline, three-day and thirty-day surveys were 97% (93/96), 49% (47/96) and 42% (40/96). Implementation challenges included short engagement window during ED visit, limited access to smartphones/computers, insufficient battery life of participant phone to access email and password, forgotten emails and passwords, multi-step verification processes for account set-up, and complaints about hospital care, most of which were effectively addressed by study personnel. CONCLUSIONS: ED patients with OUD were willing to share electronic health information and PROs, although implementation challenges were common, and more than half of participants were lost-to-follow-up after hospital discharge at 30 days. Efforts to streamline communication and remove barriers to engagement are needed to improve the collection of PROs and pathways of care in ED patients with OUD. Clinical Trial Registration ClinicalTrials.gov (NCT03985163). Date of Registration: June 10, 2019, Retrospectively registered (First enrollment June 8, 2019). https://clinicaltrials.gov/ct2/show/record/NCT03985163.


Assuntos
Transtornos Relacionados ao Uso de Opioides , Telemedicina , Adulto , Assistência ao Convalescente , Analgésicos Opioides/uso terapêutico , Eletrônica , Serviço Hospitalar de Emergência , Estudos de Viabilidade , Humanos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Alta do Paciente , Medidas de Resultados Relatados pelo Paciente
6.
Artigo em Inglês | MEDLINE | ID: mdl-34769665

RESUMO

Evaluating the use and impact of telemedicine in nursing homes is necessary to promote improvements in the quality of this practice. Even though challenges and opportunities of telemedicine are increasingly becoming well documented for geriatrics (such as improving access to healthcare, patient management, and education while reducing costs), there is still limited knowledge on how to better implement it in an inter-organizational context, especially when considering nursing homes. In this regard, this study aimed first to describe the telemedicine activity of nursing homes when cooperating with a general hospital; and then understand the behavioral differences amongst nursing homes while identifying critical factors when implementing a telemedicine project. We conducted a sequential, explanatory mixed-method study using quantitative then qualitative methods to better understand the results. Three years of teleconsultation data of twenty-six nursing homes (15 rural and 11 urban) conducting teleconsultations with a general hospital (Troyes Hospital, France) were included for the quantitative analysis, and eleven telemedicine project managers for the qualitative analysis. Between April 2018 and April 2021, 590 teleconsultations were conducted: 45% (n = 265) were conducted for general practice, 29% (n = 172) for wound care, 11% (n = 62) for diabetes management, 8% (n = 47) with gerontologist and 6% (n = 38) for dermatology. Rural nursing homes conducted more teleconsultations overall than urban ones (RR: 2.484; 95% CI: 1.083 to 5.518; p = 0.03) and included more teleconsultations for general practice (RR: 16.305; 95% CI: 3.505 to 73.523; p = 0.001). Our qualitative study showed that three critical factors are required for the implementation of a telemedicine project in nursing homes: (1) the motivation to perform teleconsultations (in other words, improving access to care and cooperation between professionals); (2) building a relevant telemedicine medical offer based on patients' and treating physicians' needs; and (3) it's specific organization in terms of time and space. Our study showed different uses of teleconsultations according to the rural or urban localization of nursing homes and that telemedicine projects should be designed to consider this aspect. Triggered by the COVID-19 pandemic, telemedicine projects in nursing homes are increasing, and observing the three critical factors presented above could be necessary to limit the failure of such projects.


Assuntos
COVID-19 , Telemedicina , Hospitais Gerais , Humanos , Casas de Saúde , Pandemias , SARS-CoV-2
7.
Artigo em Inglês | MEDLINE | ID: mdl-34769826

RESUMO

BACKGROUND: The COVID-19 pandemic has brought to light both challenges and unique opportunities regarding type 1 diabetes (T1D) management, including the usage of telemedicine platforms. METHODS: This study was conducted in a tertiary hospital diabetes clinic. All consecutive T1D patients during March and June 2021 were asked to fill out a structured anonymous questionnaire that aimed to determine their preference regarding continuous use of a virtual platform. RESULTS: In total, 126 T1D patients answered the questionnaire, of whom 51% were under the age of 40, half were men, half used insulin pumps, and 69% used continuous glucose monitoring. During the pandemic, the exposure of patients to virtual visits has grown about twofold, from 29% to 53%. Of the respondents, 49% expressed an interest in future usage of a virtual platform, but most of them preferred use in a hybrid manner. We found an association between preference to use telemedicine in the future and younger age, previous virtual platform experience, and confidence in being able to download data. CONCLUSIONS: Our data demonstrate that the COVID-19 experience has led to a growing interest of T1D patients in using the hybrid format of telemedicine. However, we still need to better understand who will benefit most from this platform and assess its cost-effectiveness and organization.


Assuntos
COVID-19 , Diabetes Mellitus Tipo 1 , Telemedicina , Glicemia , Automonitorização da Glicemia , Diabetes Mellitus Tipo 1/epidemiologia , Humanos , Masculino , Pandemias , SARS-CoV-2
8.
Artigo em Inglês | MEDLINE | ID: mdl-34769838

RESUMO

We evaluated families' perspectives on the usability of virtual visits for routine gender care for trans youth during the COVID-19 pandemic. An online survey, which included a validated telehealth usability questionnaire, was sent to families who had a virtual Gender Clinic visit between March and August 2020. A total of 87 participants completed the survey (28 trans youth, 59 caregivers). Overall, usability was rated highly, with mean scores between "quite a bit" and "completely" in all categories (usefulness, ease of use, interface and interaction quality, reliability, and satisfaction). Caregivers reported higher usability scores compared to trans youth [mean (SD) 3.43 (0.80) vs. 3.12 (0.93), p = 0.01]. All families felt that virtual visits provided for their healthcare needs. A total of 100% of youth and caregivers described virtual appointments as safer or as safe as in-person visits. A total of 94% of participants would like virtual visits after the pandemic; families would choose a mean of two virtual and one yearly in-person visit with a multidisciplinary team. Overall, virtual gender visits for trans youth had impressive usability. Participants perceived virtual visits to be safe. For the future, a combination of virtual and in-person multidisciplinary visits is the most desired model.


Assuntos
COVID-19 , Telemedicina , Adolescente , Cuidadores , Humanos , Pandemias , Reprodutibilidade dos Testes , SARS-CoV-2
9.
J Huntingtons Dis ; 10(4): 479-484, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34719505

RESUMO

BACKGROUND: The COVID-19 pandemic has increased the need for remote healthcare options among patients with Huntington's disease (HD). However, since not every HD patient is suitable for telehealth, it is important to differentiate who can be seen virtually from who should remain as in-person. Unfortunately, there are no clinical guidelines on how to evaluate HD patients for telehealth eligibility. OBJECTIVE: To standardize the teleneurology selection process in HD by implementing a screening tool that accounts for patient-specific factors. METHODS: We organized various indications and contraindications to teleneurology into a flowchart. If any indications or contraindications were met, patients were assigned to telehealth or maintained as in-person, respectively. If no indications or contraindications were met, patients were given the option of telehealth or in-person for their upcoming appointments. In two implementation cycles, we tested this screening tool among all HD patients scheduled for clinic visits, aided by chart review and phone interview. RESULTS: In a cohort of 81 patients, telehealth acceptance among eligible patients increased from 45.0%to 83.3%. Frequency of telehealth visits increased from a pre-intervention baseline of 12.8%to 28.2%. CONCLUSION: Teleneurology utilization among HD patients more than doubled across our study. Our intervention promotes consistency and patient-centeredness in HD clinical care and streamlines the overall telehealth selection process. Future studies can seek to reduce telehealth no-shows and also evaluate the utility of the motor and psychiatric criteria included in our screening tool.


Assuntos
COVID-19 , Doença de Huntington/terapia , Neurologia/normas , Aceitação pelo Paciente de Cuidados de Saúde , Preferência do Paciente , Telemedicina/normas , Adulto , Assistência Ambulatorial , COVID-19/prevenção & controle , Estudos de Coortes , Utilização de Instalações e Serviços , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neurologia/organização & administração , Design de Software , Telemedicina/organização & administração , Centros de Atenção Terciária
10.
Artigo em Inglês | MEDLINE | ID: mdl-34769765

RESUMO

Parents need information about their children's health, and the Internet has become an essential repository for this information. However, there is almost no information about which topics are the most searched, consulted, or shared, or about the main characteristics of pediatric website users. The main aim of this research was to describe the profile of the users of a pediatric website, which topics they searched for, which topics were the most consulted, and which were the most shared. Users' demographic data were analyzed regarding their use of the Internet to search for information about health. A pediatric website for parents was analyzed. A 26-item questionnaire collected demographical features of the users of the website. Descriptive and analytical analyses were performed. Most participants used general search engines for their health searches, and the most searched keywords were prurigo, barking cough, and laryngitis. The most visited topics were unexplained fever, snots, and laryngitis. The most shared were snots, lipotomy, and dizziness. The users were mainly women (67.8%), with an average age of 38.8 years, and one or two children (89%) with a mean age of 4.6 years. The users who mainly used the Internet for health purposes were women of younger age, and with a higher educational level.


Assuntos
Telemedicina , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Internet , Encaminhamento e Consulta , Ferramenta de Busca , Inquéritos e Questionários
11.
Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med ; 29(Special Issue): 1298-1303, 2021 Aug.
Artigo em Russo | MEDLINE | ID: mdl-34792881

RESUMO

The aim of the study was to study the factorial conditionality of the state of health and the features of medical activity (MA) of patients with COVID-19 who were treated on an outpatient basis using telemedicine technologies. MATERIAL AND METHODS: The study of lifestyle factors (LS) and MA was conducted by an anonymous survey of 7,743 patients with COVID-19. The patients' health was assessed based on the study of the course of the underlying disease and the presence of concomitant diseases, which were detected in 24.3% of COVID-19 patients according to the data of copying information from medical records. RESULTS: It was revealed that the prevalence of tobacco smoking was 33.25 cases per 100 respondents, 45.4% of respondents were overweight, 75.6% of patients had a low level of physical activity, 68.2% and 53.8% of patients had low medical literacy and MA, respectively. It is established that the greatest impact on the health status of the patients interviewed was provided by the bio-social activity (Smoking) (h = 0.702; m = 0.0063; p = 0.0022), physical activity (h = 0.624; m = 0.0026; p < 0.001, health behavior (h = 0.527; m = 0.0030; p < 0.001) and health literacy (h = 0.532; m = 0.0028; p < 0.001). CONCLUSION: The studied risk factors affecting the health status of COVID-19 patients, most of which are manageable, should be taken into account when forming therapeutic and preventive measures.


Assuntos
COVID-19 , Telemedicina , Humanos , Estilo de Vida , Pacientes Ambulatoriais , SARS-CoV-2
12.
Stud Health Technol Inform ; 287: 99-103, 2021 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-34795090

RESUMO

The process of maintenance of an underlying semantic model that supports data management and addresses the interoperability challenges in the domain of telemedicine and integrated care is not a trivial task when performed manually. We present a methodology that leverages the provided serializations of the Health Level Seven International (HL7) Fast Health Interoperability Resources (FHIR) specification to generate a fully functional OWL ontology along with the semantic provisions for maintaining functionality upon future changes of the standard. The developed software makes a complete conversion of the HL7 FHIR Resources along with their properties and their semantics and restrictions. It covers all FHIR data types (primitive and complex) along with all defined resource types. It can operate to build an ontology from scratch or to update an existing ontology, providing the semantics that are needed, to preserve information described using previous versions of the standard. All the results based on the latest version of HL7 FHIR as a Web Ontology Language (OWL-DL) ontology are publicly available for reuse and extension.


Assuntos
Nível Sete de Saúde , Telemedicina , Gerenciamento de Dados , Registros Eletrônicos de Saúde , Semântica
14.
J Genet Couns ; 30(5): 1214-1223, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34757671

RESUMO

The COVID-19 pandemic has significantly impacted the service delivery model (SDM) of clinical genetic counseling across the United States and Canada. A cross-sectional survey was distributed to 4,956 genetic counselors (GCs) from the American Board of Genetic Counselors and Canadian Association of Genetic Counselors mailing lists in August 2020 to assess the change in utilization of telehealth for clinical genetic counseling during the COVID-19 pandemic compared with prior to the pandemic. Data from 411 eligible clinical genetic counselors on GC attitudes and their experiences prior to and during the pandemic were collected and analyzed to explore the change in SDM, change in appointment characteristics, change in billing practices, GC perceived benefits and limitations of telehealth, and prediction of future trends in SDM in the post-pandemic era. The study showed the overall utilization of audiovisual and telephone encounters increased by 43.4% and 26.2%, respectively. The majority of respondents who provided audiovisual and telephone encounters reported increased patient volume compared with prior to the pandemic, with an average increase of 79.4% and 42.8%, respectively. There was an increase of 69.4% of GCs rendering genetic services from home offices. The percentage of participants who billed for telehealth services increased from 45.7% before the pandemic to 80.3% during the pandemic. The top GC perceived benefits of telehealth included safety for high-risk COVID patients (95.2%) and saved commute time for patients (94.7%). The top GC perceived limitations of telehealth included difficulty to conduct physician evaluation/coordinating with healthcare providers (HCP) (73.7%) and difficulty addressing non-English speaking patients (68.5%). Overall, 89.6% of GCs were satisfied with telehealth; however, 55.3% reported uncertainty whether the newly adopted SDM would continue after the pandemic subsides. Results from this study demonstrate the rapid adoption of telehealth for clinical genetic counseling services as a result of the COVID-19 pandemic, an increase in billing for these services, and support the feasibility of telehealth for genetic counseling as a longer term solution to reach patients who are geographically distant.


Assuntos
COVID-19 , Conselheiros , Telemedicina , Canadá , Estudos Transversais , Humanos , Pandemias , SARS-CoV-2 , Estados Unidos
15.
J Fr Ophtalmol ; 44(10): 1516-1522, 2021 Dec.
Artigo em Francês | MEDLINE | ID: mdl-34774347

RESUMO

INTRODUCTION: Assisted living residents are a fragile population with limited access to health care. In recent years, telemedicine has developed in several specialties, including ophthalmology. The main objective of our study is the validation of an ophthalmology telemedicine protocol in assisted living facilities. MATERIALS AND METHODS: This is a retrospective, multicentric, descriptive study including 4 assisted living facilities in the Rennes area. An ophthalmic technician examined residents for one half-day per week. The examination was performed directly in the patient's room, in bed or in a chair, with portable equipment. An ophthalmologist from our service interpreted the results remotely on a deferred basis within 7 days. Appropriate medical or surgical care was then offered to the patient depending on the diagnosis. RESULTS: We included 113 residents. A complete, interpretable examination was achieved in 84.1% of cases. One or more ophthalmic conditions were diagnosed in 57.5% of the residents. Of the residents who were then seen at the university medical center, 65% underwent a scheduled surgical procedure or laser. Visual acuity was significantly improved subsequent to the telemedicine encounter. DISCUSSION: The success rate of a complete, interpretable examination allows us to now validate our nursing home examination procedure. In addition to bringing a large amount of initially unknown information to the medical and paramedical staff of the structure, ophthalmology telemedicine allows for a significant improvement in visual acuity. CONCLUSION: This project validated the feasibility of ophthalmology telemedicine in an assisted living setting. This protocol may also be applicable to other health care settings (penitentiaries, mental health institutions, etc.).


Assuntos
Oftalmopatias , Oftalmologia , Telemedicina , Humanos , Casas de Saúde , Estudos Retrospectivos
17.
Front Public Health ; 9: 767671, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34820353

RESUMO

The telemedicine system, which has been gradually introduced, has changed dramatically with the outbreak of COVID-19. Now, with the development of related laws and technologies, the introduction of telemedicine will be further accelerated, and like the advent of smartphones, this will become an unstoppable trend of the times. However, just as there are various crimes and corruption problems in the current health system, the introduction of telemedicine may bring other problems. Therefore, it is important to anticipate the types of corruption or crimes that will occur with the introduction of telemedicine. And based on these expectations, we will have an opportunity to properly prepare for the various problems associated with telemedicine.


Assuntos
COVID-19 , Telemedicina , Crime , Humanos , República da Coreia/epidemiologia , SARS-CoV-2
18.
Harm Reduct J ; 18(1): 119, 2021 11 25.
Artigo em Inglês | MEDLINE | ID: mdl-34823538

RESUMO

BACKGROUND: The majority of individuals with opioid use disorder (OUD) face access barriers to evidence-based treatment, and the COVID-19 pandemic has exacerbated the United States (US) opioid overdose crisis. However, the pandemic has also ushered in rapid transitions to telehealth in the USA, including for substance use disorder treatment with buprenorphine. These changes have the potential to mitigate barriers to care or to exacerbate pre-existing treatment inequities. The objective of this study was to qualitatively explore Philadelphia-based low-barrier, harm-reduction oriented, opioid use disorder (OUD) treatment provider perspectives about and experiences with telehealth during the COVID-19 pandemic, and to assess their desire to offer telehealth to patients at their programs in the future. METHODS: We interviewed 22 OUD treatment prescribers and staff working outpatient programs offering OUD treatment with buprenorphine in Philadelphia during July and August 2020. All participants worked at low-barrier treatment programs that provide buprenorphine using a harm reduction-oriented approach and without mandating counseling or other requirements as a condition of treatment. We analyzed the data using thematic content analysis. RESULTS: Our analysis yielded three themes: 1/ Easier access for some: telehealth facilitates care for many patients who have difficulty attending in-person appointments due to logistical and psychological barriers; 2/ A layered digital divide: engagement with telehealth can be seriously limited by patients' access to and comfort with technology; and 3/ Clinician control: despite some clinic staff beliefs that patients should have the freedom to choose their treatment modality, patients' access to treatment via telehealth may hinge on clinician perceptions of patient "stability" rather than patient preferences. CONCLUSIONS: Telehealth may address many access issues, however, barriers to implementation remain, including patient ability and desire to attend healthcare appointments virtually. In addition, the potential for telehealth models to extend OUD care to patients currently underserved by in-person models may partially depend on clinician comfort treating patients deemed "unstable" via this modality. The ability of telehealth to expand access to OUD care for individuals who have previously struggled to engage with in-person care will likely be limited if these patients are not given the opportunity to receive treatment via telehealth.


Assuntos
Buprenorfina , COVID-19 , Transtornos Relacionados ao Uso de Opioides , Telemedicina , Buprenorfina/uso terapêutico , Humanos , Tratamento de Substituição de Opiáceos , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Pandemias , SARS-CoV-2 , Estados Unidos
19.
Methodist Debakey Cardiovasc J ; 17(4): 68-78, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34824683

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic has been the defining healthcare issue since its outbreak, consuming healthcare systems and disrupting all aspects of human life throughout 2020 and continuing through 2021. When reviewing cardiovascular disease (CVD) prevention throughout the COVID-19 pandemic, the first tendency may be to focus on the negative disruption. Months of quarantine, isolation, and missed healthcare visits or delayed care may have exacerbated the epidemic of CVD in the United States. Looking back, however, perhaps it wasn't a lost year as much as a health crisis that better prepared us for the battle to improve cardiovascular health. The pandemic brought new platforms for interacting with patients eager to engage, presenting a unique opportunity to reset how we approach preventive care. In this review, we discuss what the pandemic has taught us about caring for those vulnerable patients who were most afflicted-older adults, persons of color, and people facing adverse socioeconomic circumstances-and who continue to be impacted by CVD. We also identify opportunities for enhanced CVD prevention now boosted by the overnight adoption of telemedicine and other innovative cardiac care models. Lastly, we discuss how the COVID-19 pandemic has motivated physicians and patients alike to prioritize our health above all else, if only transiently, and how we can leverage this increased health awareness and investment into long-term, meaningful disease prevention.


Assuntos
COVID-19 , Doenças Cardiovasculares , Telemedicina , Idoso , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Atenção à Saúde , Humanos , Pandemias/prevenção & controle , SARS-CoV-2 , Estados Unidos/epidemiologia
20.
Rev Esc Enferm USP ; 55: e20210295, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34825697

RESUMO

OBJECTIVE: To map evidence on the use of digital technologies in the care of people with diabetes during the COVID-19 pandemic. METHOD: This is a scoping review, based on the JBI manual, which included scientific articles and gray literature from nine primary and seven secondary databases. Articles were independently assessed by two reviewers. Rayyan® was used to select the studies. The description of study characterization is presented in a table and tables, ending in a narrative synthesis. RESULTS: A total of 1,964 studies were identified and, after selection, 23 publications remained for analysis. It turned out that telemedicine was used in all studies and remote consultation support technologies included continuous glucose monitoring devices, glucose data analysis software, insulin delivery systems, applications, audio and/or voice communication devices, which facilitated remote diabetes mellitus monitoring and management. CONCLUSION: Telehealth, monitoring technologies, insulin delivery systems and communication devices were tools used to monitor patients with diabetes during the pandemic.


Assuntos
COVID-19 , Diabetes Mellitus , Telemedicina , Glicemia , Automonitorização da Glicemia , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/terapia , Tecnologia Digital , Humanos , Pandemias , SARS-CoV-2
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