Impact of Telemedicine Modality on Quality Metrics in Diverse Settings: Implementation Science-Informed Retrospective Cohort Study.

BACKGROUND: Video-based telemedicine (vs audio only) is less frequently used in diverse, low socioeconomic status settings. Few prior studies have evaluated the impact of telemedicine modality (ie, video vs audio-only visits) on clinical quality metrics. OBJECTIVE: The aim of this study was to assess telemedicine uptake and impact of visit modality (in-person vs video and phone visits) on primary care quality metrics in diverse, low socioeconomic status settings through an implementation science lens. METHODS: Informed by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework, we evaluated telemedicine uptake, assessed targeted primary care quality metrics by visit modality, and described provider-level qualitative feedback on barriers and facilitators to telemedicine implementation. RESULTS: We found marginally better quality metrics (ie, blood pressure and depression screening) for in-person care versus video and phone visits; de-adoption of telemedicine was marked within 2 years in our population. CONCLUSIONS: Following the widespread implementation of telemedicine during the COVID-19 pandemic, the impact of visit modality on quality outcomes, provider and patient preferences, as well as technological barriers in historically marginalized settings should be considered.

A Narrative Review of the Association Between Depression and Heart Disease Among Women: Prevalence, Mechanisms of Action, and Treatment.

PURPOSE OF REVIEW: Sex and gender differences exist with regard to the association between depression and cardiovascular disease (CVD). This narrative review describes the prevalence, mechanisms of action, and management of depression and CVD among women, with a particular focus on coronary heart disease (CHD). RECENT FINDINGS: Women versus men with incident and established CHD have a greater prevalence of depression. Comorbid depression and CHD in women may be associated with greater mortality, and treatment inertia. Proposed mechanisms unique to the association among women of depression and CHD include psychosocial, cardiometabolic, behavioral, inflammatory, hormonal, and autonomic factors. The literature supports a stronger association between CHD and the prevalence of depression in women compared to men. It remains unclear whether depression treatment influences cardiovascular outcomes, or if treatment effects differ by sex and/or gender. Further research is needed to establish underlying mechanisms as diagnostic and therapeutic targets.