Changes in Patient Characteristics in Telehealth Usage During Times of Crisis.

There is limited knowledge on whether increased telehealth usage may enhance health access to communities during natural disasters, particularly for emergency medical services. This study aimed to elucidate telehealth usage during three hurricanes in NC between 2018 and 2020 and assessed demographics of users including gender and age, insurance status, and daily rate of visits in relation to respective hurricanes. From 10,056 telehealth visits, we found that age and insurance coverage were significantly different between crisis and non-crisis times. Patients found comparative satisfaction during both times. This study suggests the use of phone and video visits to enable better access to parents with children under the age of 18 years and uninsured patients.

Using Automated Text Processing to Assess the Patient Experience of an On-Demand Tele-Urgent Care.

Novel methods are needed to evaluate the perceptions of patients using telehealth. Automated text processing methods presents a golden opportunity to classify and analyze unstructured survey responses from patients. This study analyzed 585 unstructured entries from telehealth patients. Satisfied patients who returned for a second visit applauded the efficiency and physician interactions. While unsatisfied patients who did not return for a second visit complained of misdiagnosis and inefficiencies in e-prescription. Patient experience was significantly different between weekdays and weekends (p<0.05). Overall, tele-urgent are convenient for patients however, there are current facilitators related to patient-provider interaction and health information exchange that need further optimization.

Analysis of Social Determinants and the Utilization of Pediatric Tele-Urgent Care During the COVID-19 Pandemic: Cross-sectional Study.

BACKGROUND: Telehealth is increasingly used to provide specialty consultations to infants and children receiving care. However, there is uncertainty if the COVID-19 pandemic has influenced the use of telehealth among vulnerable populations. OBJECTIVE: This research aims to compare the overall use of tele-urgent care visits for pediatric patients before and after the pandemic, especially among vulnerable populations. METHODS: We conducted a cross-sectional analysis of pediatric tele-urgent care visits at a virtual care center at a southeastern health care center. The main outcome of this study was the use of pediatrics tele-urgent visits across geographical regions with different levels of social disparities and between 2019 and 2020. RESULTS: Of 584 tele-urgent care visits, 388 (66.4%) visits occurred in 2020 during the pandemic compared to 196 (33.6%) visits in 2019. Among 808 North Carolina zip codes, 181 (22%) consisted of a high concentration of vulnerable populations, where 17.7% (56/317) of the tele-urgent care visits originated from. The majority (215/317, 67.8%) of tele-urgent care visits originated from zip codes with a low concentration of vulnerable populations. There was a significant association between the rate of COVID-19 cases and the concentration level of social factors in a given Zip Code Tabulation Area. CONCLUSIONS: The use of tele-urgent care visits for pediatric care doubled during the COVID-19 pandemic. The majority of the tele-urgent care visits after COVID-19 originated from regions where there is a low presence of vulnerable populations. In addition, our geospatial analysis found that geographic regions with a high concentration of vulnerable populations had a significantly higher rate of COVID-19-confirmed cases and deaths compared to regions with a low concentration of vulnerable populations.

Evaluation of Patient Experience During Virtual and In-Person Urgent Care Visits: Time and Cost Analysis.

Urgent care (UC) is one of the fastest growing venues of health care delivery for nonemergent conditions. This study compared the patient experience during virtual and in-person urgent care visits. We conducted a cross-sectional study of patients with the same diagnosis during Virtual Urgent Care (VUC) and in-person UC visits with the same diagnosis with regard to time and cost over a period of one year. We recorded and analyzed 16 685 urgent care visits: In-person UC (n = 14 734), VUC (n = 1262). Significant differences were found in the average total time for a visit in an in-person UC (70.89 minutes), and VUC (9.38 minutes). The average total cost of VUC ($49) and in-person UC ($142.657) differed significantly. Significant difference was found between UC turnaround time and VC turnaround time (Dependent variable (DV): 53.77, P < .01). We found significant differences in cost and time between in favor of virtual visits. Our findings suggest additional policy reform to expand the use of virtual care among target populations to improve access, reduce costs, meet the needs of patients, and reduce emergency department visits.

Evaluating the Telehealth Experience of Patients With COVID-19 Symptoms: Recommendations on Best Practices.

Positive patient experiences are associated with illness recovery and adherence to medication. To evaluate the virtual care experience for patients with COVID-19 symptoms as their chief complaints. We conducted a cross-sectional study of the first cohort of patients with COVID-19 symptoms in a virtual clinic. The main end points of this study were visit volume, wait times, visit duration, patient diagnosis, prescriptions received, and satisfaction. Of the 1139 total virtual visits, 212 (24.6%) patients had COVID-19 symptoms. The average wait time (SD) for all visits was 75.5 (121.6) minutes. The average visit duration for visits was 10.5 (4.9) minutes. The highest volume of virtual visits was on Saturdays (39), and the lowest volume was on Friday (19). Patients experienced shorter wait times (SD) on the weekdays 67.1 (106.8) minutes compared to 90.3 (142.6) minutes on the weekends. The most common diagnoses for patients with COVID-19 symptoms were upper respiratory infection. Patient wait times for a telehealth visit varied depending on the time and day of appointment. Long wait times were a major drawback in the patient experience. Based on patient-reported experience, we proposed a list of general, provider, and patient telehealth best practices.

Interpreting COVID-19 and Virtual Care Trends: Cohort Study.

BACKGROUND: The coronavirus disease (COVID-19) pandemic is rapidly spreading across the world. As of March 26, 2020, there are more than 500,000 cases and more than 25,000 deaths related to COVID-19, and the numbers are increasing by the hour. OBJECTIVE: The aim of this study was to explore the trends in confirmed COVID-19 cases in North Carolina, and to understand patterns in virtual visits related to symptoms of COVID-19. METHODS: We conducted a cohort study of confirmed COVID-19 cases and patients using an on-demand, statewide virtual urgent care center. We collected data from February 1, 2020, to March 15, 2020. Institutional Review Board exemption was obtained prior to the study. RESULTS: As of March, 18 2020, there were 92 confirmed COVID-19 cases and 733 total virtual visits. Of the total visits, 257 (35.1%) were related to COVID-19-like symptoms. Of the COVID-19-like visits, the number of females was 178 (69.2%). People in the age groups of 30-39 years (n=67, 26.1%) and 40-49 years (n=64, 24.9%) were half of the total patients. Additionally, approximately 96.9% (n=249) of the COVID-like encounters came from within the state of North Carolina. Our study shows that virtual care can provide efficient triaging in the counties with the highest number of COVID-19 cases. We also confirmed that the largest spread of the disease occurs in areas with a high population density as well as in areas with major airports. CONCLUSIONS: The use of virtual care presents promising potential in the fight against COVID-19. Virtual care is capable of reducing emergency room visits, conserving health care resources, and avoiding the spread of COVID-19 by treating patients remotely. We call for further adoption of virtual care by health systems across the United States and the world during the COVID-19 pandemic.

Analyzing the Demographics of Virtual Care Users.

Using telemedicine to provide care is an attractive alternative for patients. However, few studies have examined the demographics of the patients using virtual care. In this paper, we investigate the demographic features of the Virtual Care (VC) users; Age, gender, roles, and preferred methods of communication are studied.

Advancing health equity and access using telemedicine: a geospatial assessment.

INTRODUCTION: Health disparity affects both urban and rural residents, with evidence showing that rural residents have significantly lower health status than urban residents. Health equity is the commitment to reducing disparities in health and in its determinants, including social determinants. OBJECTIVE: This article evaluates the reach and context of a virtual urgent care (VUC) program on health equity and accessibility with a focus on the rural underserved population. MATERIALS AND METHODS: We studied a total of 5343 patient activation records and 2195 unique encounters collected from a VUC during the first 4 quarters of operation. Zip codes served as the analysis unit and geospatial analysis and informatics quantified the results. RESULTS: The reach and context were assessed using a mean accumulated score based on 11 health equity and accessibility determinants calculated for each zip code. Results were compared among VUC users, North Carolina (NC), rural NC, and urban NC averages. CONCLUSIONS: The study concluded that patients facing inequities from rural areas were enabled better healthcare access by utilizing the VUC. Through geospatial analysis, recommendations are outlined to help improve healthcare access to rural underserved populations.

Evaluation of Perceived Usability and Utilization of a Virtual Care Program Among Adolescents and Geriatrics.

The advancement of telemedicine has allowed to reach users of various demographics. In this paper we compare two cohorts, adolescents and geriatrics at a virtual care clinic. We calculated frequent chief complaints, modality of communication, and the distribution of gender. Our findings show that elderly female population prefers telemedicine more than men, and adolescents are more likely to use video calls than the geriatric population.

Factors Determining Patients' Choice Between Mobile Health and Telemedicine: Predictive Analytics Assessment.

BACKGROUND: The solution to the growing problem of rural residents lacking health care access may be found in the use of telemedicine and mobile health (mHealth). Using mHealth or telemedicine allows patients from rural or remote areas to have better access to health care. OBJECTIVE: The objective of this study was to understand factors influencing the choice of communication medium for receiving care, through the analysis of mHealth versus telemedicine encounters with a virtual urgent clinic. METHODS: We conducted a postdeployment evaluation of a new virtual health care service, Virtual Urgent Clinic, which uses mHealth and telemedicine modalities to provide patient care. We used a multinomial logistic model to test the significance and predictive power of a set of features in determining patients' preferred method of telecare encounters-a nominal outcome variable of two levels (mHealth and telemedicine). RESULTS: Postdeployment, 1403 encounters were recorded, of which 1228 (87.53%) were completed with mHealth and 175 (12.47%) were telemedicine encounters. Patients' sex (P=.004) and setting (P<.001) were the most predictive determinants of their preferred method of telecare delivery, with significantly small P values of less than .01. Pearson chi-square test returned a strong indication of dependency between chief concern and encounter mediums, with an extremely small P<.001. Of the 169 mHealth patients who responded to the survey, 154 (91.1%) were satisfied by their encounter, compared with 31 of 35 (89%) telemedicine patients. CONCLUSIONS: We studied factors influencing patients' choice of communication medium, either mHealth or telemedicine, for a virtual care clinic. Sex and geographic location, as well as their chief concern, were strong predictors of patients' choice of communication medium for their urgent care needs. This study suggests providing the option of mHealth or telemedicine to patients, and suggesting which medium would be a better fit for the patient based on their characteristics.

Multivariate Analysis of Physicians' Practicing Behaviors in an Urgent Care Telemedicine Intervention.

When assessing the characteristics and performance of telemedicine interventions, most studies followed a patient- centric approach, leaving the telemedicine providers' role out of consideration. As a result, little was known about the demographics and prescription pattern of telemedicine physicians, the knowledge of which is integral to a holistic evaluation of the virtual delivery of accountable care. To fill this gap, our study explored how physicians' traits and encounter-specific characteristics correlate with prescription outcomes, using multivariate analyses. Significant inter-physician variation in prescription behaviors was observed and analyzed in sub-groups. The average Virtual Urgent Care physician's prescription likelihood was 69% with a mean prescription count of 0.98; male physicians and primary care providers tended to prescribe both more often and with a greater number of medications. This study called attention to the quality and reproducibility of telemedicine providers' prescription decision and warned the likely absence of well-defined practice guidelines for delivering virtual care.