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1.
Open Heart ; 8(1)2021 06.
Artículo en Inglés | MEDLINE | ID: mdl-34088789

RESUMEN

AIMS: In response to the COVID-19 pandemic, the UK was placed under strict lockdown measures on 23 March 2020. The aim of this study was to quantify the effects on physical activity (PA) levels using data from the prospective Triage-HF Plus Evaluation study. METHODS: This study represents a cohort of adult patients with implanted cardiac devices capable of measuring activity by embedded accelerometery via a remote monitoring platform. Activity data were available for the 4 weeks pre-implementation and post implementation of 'stay at home' lockdown measures in the form of 'minutes active per day' (min/day). RESULTS: Data were analysed for 311 patients (77.2% men, mean age 68.8, frailty 55.9%. 92.2% established heart failure (HF) diagnosis, of these 51.2% New York Heart Association II), with comorbidities representative of a real-world cohort.Post-lockdown, a significant reduction in median PA equating to 20.8 active min/day was seen. The reduction was uniform with a slightly more pronounced drop in PA for women, but no statistically significant difference with respect to age, body mass index, frailty or device type. Activity dropped in the immediate 2-week period post-lockdown, but steadily returned thereafter. Median activity week 4 weeks post-lockdown remained significantly lower than 4 weeks pre-lockdown (p≤0.001). CONCLUSIONS: In a population of predominantly HF patients with cardiac devices, activity reduced by approximately 20 min active per day in the immediate aftermath of strict COVID-19 lockdown measures. TRIAL REGISTRATION NUMBER: NCT04177199.


Asunto(s)
Acelerometría , COVID-19 , Control de Enfermedades Transmisibles , Insuficiencia Cardíaca , Monitoreo Fisiológico , Distanciamiento Físico , Telemedicina , Acelerometría/instrumentación , Acelerometría/métodos , Acelerometría/estadística & datos numéricos , Actividades Cotidianas , Anciano , COVID-19/epidemiología , COVID-19/prevención & control , Control de Enfermedades Transmisibles/métodos , Control de Enfermedades Transmisibles/estadística & datos numéricos , Ejercicio Físico , Femenino , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/epidemiología , Humanos , Masculino , Monitoreo Fisiológico/instrumentación , Monitoreo Fisiológico/métodos , Monitoreo Fisiológico/estadística & datos numéricos , SARS-CoV-2 , Telemedicina/instrumentación , Telemedicina/métodos , Telemedicina/estadística & datos numéricos , Reino Unido/epidemiología , Dispositivos Electrónicos Vestibles
3.
Appl Clin Inform ; 12(3): 445-458, 2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-34107542

RESUMEN

BACKGROUND: The COVID-19 pandemic led to dramatic increases in telemedicine use to provide outpatient care without in-person contact risks. Telemedicine increases options for health care access, but a "digital divide" of disparate access may prevent certain populations from realizing the benefits of telemedicine. OBJECTIVES: The study aimed to understand telemedicine utilization patterns after a widespread deployment to identify potential disparities exacerbated by expanded telemedicine usage. METHODS: We performed a cross-sectional retrospective analysis of adults who scheduled outpatient visits between June 1, 2020 and August 31, 2020 at a single-integrated academic health system encompassing a broad range of subspecialties and a large geographic region in the Upper Midwest, during a period of time after the initial surge of COVID-19 when most standard clinical services had resumed. At the beginning of this study period, approximately 72% of provider visits were telemedicine visits. The primary study outcome was whether a patient had one or more video-based visits, compared with audio-only (telephone) visits or in-person visits only. The secondary outcome was whether a patient had any telemedicine visits (video-based or audio-only), compared with in-person visits only. RESULTS: A total of 197,076 individuals were eligible (average age = 46 years, 56% females). Increasing age, rural status, Asian or Black/African American race, Hispanic ethnicity, and self-pay/uninsured status were significantly negatively associated with having a video visit. Digital literacy, measured by patient portal activation status, was significantly positively associated with having a video visit, as were Medicaid or Medicare as payer and American Indian/Alaskan Native race. CONCLUSION: Our findings reinforce previous evidence that older age, rural status, lower socioeconomic status, Asian race, Black/African American race, and Hispanic/Latino ethnicity are associated with lower rates of video-based telemedicine use. Health systems and policies should seek to mitigate such barriers to telemedicine when possible, with efforts such as digital literacy outreach and equitable distribution of telemedicine infrastructure.


Asunto(s)
COVID-19/epidemiología , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Disparidades en Atención de Salud/estadística & datos numéricos , Pandemias/estadística & datos numéricos , Telemedicina/estadística & datos numéricos , Adolescente , Adulto , Anciano , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto Joven
4.
Headache ; 61(5): 734-739, 2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-34021595

RESUMEN

OBJECTIVE: We sought to investigate the patient experience of telemedicine for headache care during the coronavirus disease 2019 (COVID-19) pandemic. BACKGROUND: The use of telemedicine has rapidly expanded and evolved since the beginning of the COVID-19 pandemic. Telemedicine eliminates the physical and geographic barriers to health care, preserves personal protective equipment, and prevents the spread of COVID-19 by allowing encounters to happen in a socially distanced way. However, few studies have assessed the patient perspective of telemedicine for headache care. METHODS: The American Migraine Foundation (AMF) designed a standardized electronic questionnaire to assess the patient experience of telemedicine for headache care between March and September 2020 to help inform future quality improvement as part of its patient advocacy initiative. The date parameters were identified as the emergence of severe acute respiratory syndrome coronavirus 2 disease and the declaration of a national emergency in the United States. The questionnaire was distributed electronically to more than 100,000 members of the AMF community through social media platforms and the AMF email database. RESULTS: A total of 1172 patients responded to our electronic questionnaire, with 1098 complete responses. The majority, 1081/1153 (93.8%) patients, had a previous headache diagnosis prior to the telemedicine encounter. A total of 648/1127 (57.5%) patients reported that they had used telemedicine for headache care during the study period. Among those who participated in telehealth visits, 553/647 (85.5%) patients used it for follow-up visits; 94/647 (14.5%) patients used it for new patient visits. During the telemedicine encounters, 282/645 (43.7%) patients were evaluated by headache specialists, 222/645 (34.4%) patients by general neurologists, 198/645 (30.7%) patients by primary care providers, 73/645 (11.3%) patients by headache nurse practitioners, and 21/645 (3.2%) patients by headache nurses. Only 47/633 (7.4%) patients received a new headache diagnosis from telemedicine evaluation, whereas the other 586/633 (92.6%) patients did not have a change in their diagnoses. During these visits, a new treatment was prescribed for 358/636 (52.3%) patients, whereas 278/636 (43.7%) patients did not have changes made to their treatment plan. The number (%) of patients who rated the telemedicine headache care experience as "very good," "good," "fair," "poor," and "other" were 396/638 (62.1%), 132/638 (20.7%), 67/638 (10.5%), 23/638 (3.6%), and 20/638 (3.1%), respectively. Detailed reasons for "other" are listed in the manuscript. Most patients, 573/638 (89.8%), indicated that they would prefer to continue to use telemedicine for their headache care, 45/638 (7.1%) patients would not, and 20/638 (3.1%) patients were unsure. CONCLUSIONS: Our study evaluating the patient perspective demonstrated that telemedicine facilitated headache care for many patients during the COVID-19 pandemic, resulting in high patient satisfaction rates, and a desire to continue to use telemedicine for future headache care among those who completed the online survey.


Asunto(s)
Cuidados Posteriores/estadística & datos numéricos , COVID-19 , Trastornos de Cefalalgia/terapia , Satisfacción del Paciente/estadística & datos numéricos , Evaluación de Procesos, Atención de Salud/estadística & datos numéricos , Telemedicina/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Fundaciones , Trastornos de Cefalalgia/diagnóstico , Encuestas de Atención de la Salud , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven
5.
Nurse Pract ; 46(6): 43-47, 2021 06 01.
Artículo en Inglés | MEDLINE | ID: mdl-34004641

RESUMEN

ABSTRACT: In the third and final article in this series, patient and provider dynamics are explored, built from real-life telehealth experiences. The Four Habits Model is utilized to examine the virtual visit.


Asunto(s)
COVID-19/diagnóstico , COVID-19/terapia , Enfermeras Practicantes/normas , Guías de Práctica Clínica como Asunto , Telemedicina/estadística & datos numéricos , Telemedicina/normas , Adaptación Psicológica , Adulto , Anciano , Anciano de 80 o más Años , COVID-19/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , SARS-CoV-2 , Estrés Psicológico , Estados Unidos/epidemiología
6.
Med Arch ; 75(1): 50-55, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-34012200

RESUMEN

Background: Consumers' willingness to use health chatbots can eventually determine if the adoption of health chatbots will succeed in delivering healthcare services for combating COVID-19. However, little research to date has empirically explored influential factors of consumer willingness toward using these novel technologies, and the effect of individual differences in predicting this willingness. Objectives: This study aims to explore (a) the influential factors of consumers' willingness to use health chatbots related to COVID-19, (b) the effect of individual differences in predicting willingness, and (c) the likelihood of using health chatbots in the near future as well as the challenges/barriers that could hinder peoples' motivations. Methods: An online survey was conducted which comprised of two sections. Section one measured participants' willingness by evaluating the following six factors: performance efficacy, intrinsic motivation, anthropomorphism, social influence, facilitating conditions, and emotions. Section two included questions on demographics, the likelihood of using health chatbots in the future, and concerns that could impede such motivation. Results: A total of 166 individuals provided complete responses. Although 40% were aware of health chatbots and only 24% had used them before, about 84% wanted to use health chatbots in the future. The strongest predictors of willingness to use health chatbots came from the intrinsic motivation factor whereas the next strongest predictors came from the performance efficacy factor. Nearly 39.5% of participants perceived health chatbots to have human-like features such as consciousness and free will, but no emotions. About 38.4% were uncertain about the ease of using health chatbots. Conclusion: This study contributes toward theoretically understanding factors influencing peoples' willingness to use COVID-19-related health chatbots. The findings also show that the perception of chatbots' benefits outweigh the challenges.


Asunto(s)
Inteligencia Artificial/estadística & datos numéricos , Actitud Frente a la Salud , COVID-19/prevención & control , Comportamiento del Consumidor/estadística & datos numéricos , Telemedicina/estadística & datos numéricos , Adulto , COVID-19/epidemiología , Humanos , Masculino , Medios de Comunicación Sociales , Percepción Social , Encuestas y Cuestionarios
7.
Acta Otorrinolaringol Esp ; 72(3): 190-194, 2021.
Artículo en Español | MEDLINE | ID: mdl-34017146

RESUMEN

Objective: To describe how the ENT and Head and Neck departments of the HMM and HVC hospitals were managed during the COVID-19 state of alert and to analyse the results obtained to assess the usefulness of telephone consultations in our specialty. Material and methods: From March 16, the ENT and Head and Neck departments of the HMM and HVC Hospitals began telephone consultations. Due to the disparity in the actions of the different department members, the decision was made to create a protocol to manage these consultations which started to be implemented March 23. Results: During the study period, 1054 patients were attended in the consultations of both departments; 663 (62.9%) were first visits and 391 (37.10%) were successive visits. Twenty-one percent (229) of the consultations could be resolved by telephone, 10.82% (114) required face-to-face care, 57.40% (605) were indicated for an on-demand check-up depending on their disease course, and 10.05% (106) of the patients could not be reached by telephone. Discussion: The state of alarm caused by COVID-19 has been a determining factor in how we undertake our care work. In the ENT and Head and Neck departments of the HMM and HVC Hospitals we decided to carry out consultations by telephone as an alternative to the traditional consultation. During this period, we have observed that up to 21.73% of the consultations could be dealt with by telephone. Conclusion: The telephone consultation seems to be a very useful tool to attend our patients avoiding the risk of COVID-19 infection during the state of alarm. Furthermore, according to the data analysed and the different studies, it seems a good alternative to the traditional consultation in selected patients.


Asunto(s)
COVID-19/epidemiología , Otolaringología/estadística & datos numéricos , Pandemias , Telemedicina/estadística & datos numéricos , Teléfono/estadística & datos numéricos , COVID-19/diagnóstico , Humanos , Otolaringología/métodos , España/epidemiología , Telemedicina/métodos
8.
J Clin Psychiatry ; 82(2)2021 03 03.
Artículo en Inglés | MEDLINE | ID: mdl-33979485

RESUMEN

OBJECTIVE: The early COVID-19 pandemic resulted in great psychosocial disruption and stress, raising speculation that psychiatric disorders may worsen. This study aimed to identify patients vulnerable to worsening mental health during the COVID-19 pandemic. METHODS: This retrospective observational study used electronic health records from March 9 to May 31 in 2019 (n = 94,720) and 2020 (n = 94,589) in a large, community-based health care system. Percent change analysis compared variables standardized to the average patient population for the respective time periods. RESULTS: Compared to 2019, psychiatric visits increased significantly (P < .0001) in 2020, with the majority being telephone/video-based (+264%). Psychiatric care volume increased overall (7%), with the greatest increases in addiction (+42%), behavioral health in primary care (+17%), and adult psychiatry (+5%) clinics. While patients seeking care with preexisting psychiatric diagnoses were mainly stable (−2%), new patients declined (−42%). Visits for substance use (+51%), adjustment (+15%), anxiety (+12%), bipolar (+9%), and psychotic (+6%) disorder diagnoses, and for patients aged 18­25 years (+4%) and 26­39 years (+4%), increased. Child/adolescent and older adult patient visits decreased (−22.7% and −5.5%, respectively), and fewer patients identifying as White (−3.8%) or male (−5.0) or with depression (−3%) or disorders of childhood (−2%) sought care. CONCLUSIONS: The early COVID-19 pandemic was associated with dramatic changes in psychiatric care facilitated by a rapid telehealth care transition. Patient volume, demographic, and diagnostic changes may reflect comfort with telehealth or navigating the psychiatric care system. These data can inform health system resource management and guide future work examining how care delivery changes impact psychiatric care quality and access.


Asunto(s)
COVID-19 , Servicios de Salud Comunitaria/estadística & datos numéricos , Trastornos Mentales/epidemiología , Trastornos Mentales/terapia , Servicios de Salud Mental/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Atención Primaria de Salud/estadística & datos numéricos , Telemedicina/estadística & datos numéricos , Adolescente , Adulto , Niño , Registros Electrónicos de Salud , Femenino , Humanos , Masculino , Trastornos Mentales/diagnóstico , Persona de Mediana Edad , Estudios Retrospectivos , Adulto Joven
9.
Swiss Med Wkly ; 151: w20500, 2021 04 26.
Artículo en Inglés | MEDLINE | ID: mdl-34000061

RESUMEN

  INTRODUCTION: Complex drug management is a common challenge in the treatment of geriatric patients. Pandemic scenarios, such as the current one (COVID-19), call for a reduction of face-to-face meetings, especially for elderly patients. Therefore, the aim of the present study was to compare the innovative concept of applying telemedical assessment to geriatric patients in the emergency department (ED) with ED standard treatment. The therapeutic recommendations regarding drug management from the two assessments were compared. A special focus was the use of potentially inadequate drugs (PIMs) for geriatric patients according to the “Fit for the Aged” (FORTA) classification. METHODS: 50 patients (40% female) aged ≥70 years and assessed with an Identification of Seniors at Risk Score (ISAR score) of ≥2 admitted to the ED were prospectively enrolled in this study between November 2017 and February 2018. In addition to the standard treatment in the ED, co-evaluation via video transmission was independently carried out by a board-certified geriatrician. Drug recommendations by ED physicians (A) and the geriatrician (B) were compared. RESULTS: There was a significantly higher frequency of recommendations regarding changes to preexisting medication (p <0.001, n = 50) via geriatric telemedicine in comparison with standard ED treatment. The geriatrician intervened significantly more often than the ED physicians: discontinuation of a drug, p <0.001; start of a new drug, p = 0.004; dose change of a drug, p = 0.001; n = 50). Based on the additional therapy recommendations of the geriatrician, the amount of medication taken by the patient was significantly reduced compared with standard ED treatment (ED assessment t(49) = 0.622 vs geriatrician’s assessment t(49) = 4.165; p <0.001; n = 50). Additionally, the number of PIMs was significantly reduced compared with standard medical treatment (p <0.001). The geriatrician changed 53.9% of the drugs (35/65) whereas the ED physicians changed only 12.3% (8/65). Recommendations for immediate drug therapy, however, were made more frequently by ED physicians (p <0.039, n = 50). DISCUSSION: An early assessment of elderly emergency patients by a geriatrician had a significant impact on the number of drug interventions in the ED. The number of PIMs could be significantly reduced. Whether this also has a positive effect on the further inpatient course needs to be investigated in further prospective studies. The study was retrospectively registered at ClinicalTrials.gov (NCT04148027).  .


Asunto(s)
Prescripciones de Medicamentos/estadística & datos numéricos , Servicio de Urgencia en Hospital/estadística & datos numéricos , Evaluación Geriátrica/estadística & datos numéricos , Geriatría/estadística & datos numéricos , Telemedicina/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , COVID-19 , Femenino , Geriatría/métodos , Implementación de Plan de Salud , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Proyectos Piloto , Estudios Prospectivos , Reproducibilidad de los Resultados , Medición de Riesgo , SARS-CoV-2 , Telemedicina/métodos
11.
J Marital Fam Ther ; 47(2): 259-288, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33837968

RESUMEN

The delivery of videoconferencing psychotherapy (VCP) has been found to be an efficacious, acceptable and feasible treatment modality for individual therapy. However, less is known about the use of VCP for couple and family therapy (CFT). The focus of this systematic review was to examine the efficacy, feasibility and acceptability of using VCP as a treatment delivery modality for CFT. A systematic search was conducted, data relating to efficacy, feasibility and acceptability were extracted from included studies. The search returned 7,112 abstracts, with 37 papers (0.005%) included. The methods of the review were pre-registered (PROSPERO; CRD42018106137). VCP for CFT was demonstrated to be feasible and acceptable. A meta-analysis was not conducted; however, results from the included studies indicate that VCP is an efficacious delivery method for CFT. Recommendations for future research and implications regarding clinical practice are made, which may be of interest to practitioners given the COVID-19 pandemic.


Asunto(s)
Terapia de Parejas/organización & administración , Terapia Familiar/organización & administración , Fisioterapeutas/estadística & datos numéricos , Consulta Remota/organización & administración , Telerrehabilitación/organización & administración , Actitud del Personal de Salud , COVID-19/epidemiología , Femenino , Humanos , Masculino , Telemedicina/estadística & datos numéricos
12.
J Psychosoc Oncol ; 39(3): 428-444, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33886433

RESUMEN

PURPOSE: Describe the impact of the COVID-19 pandemic on the work structure, daily care provided, personal lives, and practice models for pediatric oncology social workers (POSW). RESEARCH APPROACH: Cross-sectional online survey on APOSW professional listserv from 10/5/2020 to 11/20/2020. SAMPLE: 101 surveys were completed by POSW from 31 states and the District of Columbia. METHODS: Data were summarized descriptively and with semantic content analyses. FINDINGS: Surveys were completed by social workers from diverse work settings. Seventy-five percent of social workers were deemed "essential," and 45% reported working primarily from home. Most (56%) adopted a form of telehealth for patient care, although 71% did not receive telehealth training and 87% perceived lesser quality of care with telehealth. Nearly 80% of respondents reported not being able to provide optimum psychosocial care. Notable stressors on social work practice included worry about exposure to COVID-19, limited resources, lack of contact with and increased emotional needs of patients and families, managing patient and family concerns about COVID-19, and isolation from colleagues. Inequity and social justice issues were identified. Despite challenges, over 60% of POSW endorsed positive changes to their work life resulting from the pandemic. CONCLUSIONS/INTERPRETATION: As the COVID-19 pandemic persists, POSW have adapted to a changing work environment, different modes of service provision, and stark health inequities to meet the needs of patients and families in a crisis. IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS: COVID-19 vastly impacted the personal and professional lives of POSW, warranting attentiveness to lessons learned and future directions.


Asunto(s)
COVID-19 , Neoplasias/rehabilitación , Intervención Psicosocial/estadística & datos numéricos , Trabajadores Sociales/psicología , Trabajadores Sociales/estadística & datos numéricos , Telemedicina/estadística & datos numéricos , Adulto , Niño , Estudios Transversales , Humanos , Teletrabajo/estadística & datos numéricos
13.
J Med Internet Res ; 23(4): e26994, 2021 04 16.
Artículo en Inglés | MEDLINE | ID: mdl-33822737

RESUMEN

BACKGROUND: Accompanying the rising rates of reported mental distress during the COVID-19 pandemic has been a reported increase in the use of digital technologies to manage health generally, and mental health more specifically. OBJECTIVE: The objective of this study was to systematically examine whether there was a COVID-19 pandemic-related increase in the self-reported use of digital mental health tools and other technologies to manage mental health. METHODS: We analyzed results from a survey of 5907 individuals in the United States using Amazon Mechanical Turk (MTurk); the survey was administered during 4 week-long periods in 2020 and survey respondents were from all 50 states and Washington DC. The first set of analyses employed two different logistic regression models to estimate the likelihood of having symptoms indicative of clinical depression and anxiety, respectively, as a function of the rate of COVID-19 cases per 10 people and survey time point. The second set employed seven different logistic regression models to estimate the likelihood of using seven different types of digital mental health tools and other technologies to manage one's mental health, as a function of symptoms indicative of clinical depression and anxiety, rate of COVID-19 cases per 10 people, and survey time point. These models also examined potential interactions between symptoms of clinical depression and anxiety, respectively, and rate of COVID-19 cases. All models controlled for respondent sociodemographic characteristics and state fixed effects. RESULTS: Higher COVID-19 case rates were associated with a significantly greater likelihood of reporting symptoms of depression (odds ratio [OR] 2.06, 95% CI 1.27-3.35), but not anxiety (OR 1.21, 95% CI 0.77-1.88). Survey time point, a proxy for time, was associated with a greater likelihood of reporting clinically meaningful symptoms of depression and anxiety (OR 1.19, 95% CI 1.12-1.27 and OR 1.12, 95% CI 1.05-1.19, respectively). Reported symptoms of depression and anxiety were associated with a greater likelihood of using each type of technology. Higher COVID-19 case rates were associated with a significantly greater likelihood of using mental health forums, websites, or apps (OR 2.70, 95% CI 1.49-4.88), and other health forums, websites, or apps (OR 2.60, 95% CI 1.55-4.34). Time was associated with increased odds of reported use of mental health forums, websites, or apps (OR 1.20, 95% CI 1.11-1.30), phone-based or text-based crisis lines (OR 1.20, 95% CI 1.10-1.31), and online, computer, or console gaming/video gaming (OR 1.12, 95% CI 1.05-1.19). Interactions between COVID-19 case rate and mental health symptoms were not significantly associated with any of the technology types. CONCLUSIONS: Findings suggested increased use of digital mental health tools and other technologies over time during the early stages of the COVID-19 pandemic. As such, additional effort is urgently needed to consider the quality of these products, either by ensuring users have access to evidence-based and evidence-informed technologies and/or by providing them with the skills to make informed decisions around their potential efficacy.


Asunto(s)
COVID-19/psicología , Servicios de Salud Mental/estadística & datos numéricos , Salud Mental , Telemedicina/estadística & datos numéricos , Adulto , COVID-19/epidemiología , Femenino , Humanos , Masculino , Trastornos Mentales/terapia , Pandemias , SARS-CoV-2/aislamiento & purificación , Encuestas y Cuestionarios , Tecnología , Estados Unidos/epidemiología
14.
Curr Oncol ; 28(2): 1507-1517, 2021 04 10.
Artículo en Inglés | MEDLINE | ID: mdl-33920247

RESUMEN

The COVID-19 pandemic has shifted oncology practices to prioritize patient safety while maintaining necessary treatment delivery. We obtained patient feedback on pandemic-based practices in our radiotherapy department to improve quality of patient care and amend policies as needed. We developed a piloted questionnaire which quantitatively and qualitatively assessed patients' pandemic-related concerns and satisfaction with specific elements of their care. Adult patients who were treated at our Centre between 23 March and 31 May 2020, had initial consultation via telemedicine, and received at least five outpatient fractions of radiotherapy were invited to complete the survey by telephone or online. Relative frequencies of categorical and ordinal responses were then calculated. Fifty-three (48%) out of 110 eligible patients responded: 32 patients by phone and 21 patients online. Eighteen participants (34%) admitted to feeling anxious about hospital appointments, and only five (9%) reported treatment delays. Forty-eight patients (91%) reported satisfaction with their initial telemedicine appointment. The majority of patients indicated that healthcare workers took appropriate precautions, making them feel safe. Overall, all 53 patients (100%) reported being satisfied with their treatment experience during the pandemic. Patient feedback is needed to provide the highest quality of patient care as we adapt to the current reality.


Asunto(s)
COVID-19/prevención & control , Neoplasias/radioterapia , Satisfacción del Paciente/estadística & datos numéricos , SARS-CoV-2/aislamiento & purificación , Encuestas y Cuestionarios , Adolescente , Adulto , Anciano , COVID-19/epidemiología , COVID-19/virología , Estudios Transversales , Femenino , Humanos , Masculino , Oncología Médica/métodos , Oncología Médica/estadística & datos numéricos , Persona de Mediana Edad , Pandemias , Oncología por Radiación/métodos , Oncología por Radiación/estadística & datos numéricos , SARS-CoV-2/fisiología , Telemedicina/métodos , Telemedicina/estadística & datos numéricos , Adulto Joven
15.
Int J Pediatr Otorhinolaryngol ; 145: 110712, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-33887549

RESUMEN

OBJECTIVE: The objective of this study was to evaluate the feasibility of telehealth visits and compare office-based visits for pediatric patients undergoing evaluation of recurrent acute otitis media or sleep-disordered breathing. METHODS: A retrospective cohort study compared telehealth patients with matched controls seen in the office. The feasibility of a thorough patient evaluation in a single telehealth visit without a follow-up office visit was assessed. Both groups were also compared for completeness of physical exam, management, follow-up recommendations, and correlation of physical exam findings with intraoperative findings. RESULTS: 100 children [mean age (SD) = 20.7 (15.6) months] with a chief complaint of recurrent acute otitis media and 128 children [5.4 (3.2) years] with a chief complaint of sleep-disordered breathing were evaluated. Recommendations for surgery, additional studies, or routine follow-up were similar between telehealth and office-based groups. Physical exam feasibility was significantly different for the nasal cavity, oropharynx, and middle ear (P < .001). Patients who underwent office-based consultation were much more likely to have findings of middle ear fluid at the time of tympanostomy tube placement (79.3% vs 39.3%, P = .002). There was no significant difference between preoperative and intraoperative tonsil size discrepancies (P = .749). CONCLUSION: Telehealth can be used successfully for the evaluation of pediatric patients with sleep-disordered breathing; however, reliance on history alone may result in unnecessary tympanostomy tube placement in patients with recurrent acute otitis media. Physical examination of the oropharynx, nasal cavity, and middle ear via telehealth presents a unique challenge in pediatric otolaryngology.


Asunto(s)
Atención Ambulatoria/estadística & datos numéricos , Visita a Consultorio Médico/estadística & datos numéricos , Otolaringología , Telemedicina/estadística & datos numéricos , Preescolar , Humanos , Lactante , Ventilación del Oído Medio , Estudios Retrospectivos
16.
Psychopharmacol Bull ; 51(1): 59-68, 2021 01 12.
Artículo en Inglés | MEDLINE | ID: mdl-33897063

RESUMEN

Background: The novel coronavirus pandemic (COVID-19) led healthcare providers, including mental health providers, across the U.S. to swiftly shift to telemedicine. Objectives: This shift gave our Department of Psychiatry a chance to better understand key challenges and opportunities vis-à-vis virtual mental healthcare. We aimed to obtain provider feedback on the use of telepsychiatry and to learn from the provider perspective about patient experiences with video visits. This information will be used to inform the telemedicine strategy at a systems level within our psychiatry department, our academic health system, as well as the field of telemedicine as a whole. Design and Sample: A 22-item online questionnaire comprising 16 quantitative and six qualitative items was distributed to providers currently using video visits to provide care. Results: A total of 89 mental health providers completed the questionnaire. Outcomes demonstrated that while providers perceive challenges associated with virtual care (e.g., fatigue, technology-related issues, and age-related concerns), they also recognize a number of benefits to themselves and their patients (e.g., convenience and increased access). Overall, provider satisfaction, comfort, and willingness to use telepsychiatry was high. Conclusions: The vast majority of providers adapted quickly to the use of virtual platforms; many endorse advantages that suggest virtual care will continue to be a modality they provide in the future, post-COVID-19. It will be important to continue to evaluate aspects of virtual care that may limit clinical assessments and to optimize use to improve access, convenience, and cost-efficiency of mental healthcare delivery.


Asunto(s)
COVID-19 , Atención a la Salud/estadística & datos numéricos , Personal de Salud/estadística & datos numéricos , Trastornos Mentales/terapia , Telemedicina/estadística & datos numéricos , Atención a la Salud/métodos , Encuestas de Atención de la Salud , Humanos , Psiquiatría/métodos , Psiquiatría/estadística & datos numéricos
17.
J Med Internet Res ; 23(4): e26558, 2021 04 29.
Artículo en Inglés | MEDLINE | ID: mdl-33882020

RESUMEN

BACKGROUND: The COVID-19 pandemic has caused an abrupt reduction in the use of in-person health care, accompanied by a corresponding surge in the use of telehealth services. However, the extent and nature of changes in health care utilization during the pandemic may differ by care setting. Knowledge of the impact of the pandemic on health care utilization is important to health care organizations and policy makers. OBJECTIVE: The aims of this study are (1) to evaluate changes in in-person health care utilization and telehealth visits during the COVID-19 pandemic and (2) to assess the difference in changes in health care utilization between the pandemic year 2020 and the prepandemic year 2019. METHODS: We retrospectively assembled a cohort consisting of members of a large integrated health care organization, who were enrolled between January 6 and November 2, 2019 (prepandemic year), and between January 5 and October 31, 2020 (pandemic year). The rates of visits were calculated weekly for four settings: inpatient, emergency department (ED), outpatient, and telehealth. Using Poisson models, we assessed the impact of the pandemic on health care utilization during the early days of the pandemic and conducted difference-in-deference (DID) analyses to measure the changes in health care utilization, adjusting for the trend of health care utilization in the prepandemic year. RESULTS: In the early days of the pandemic, we observed significant reductions in inpatient, ED, and outpatient utilization (by 30.2%, 37.0%, and 80.9%, respectively). By contrast, there was a 4-fold increase in telehealth visits between weeks 8 (February 23) and 12 (March 22) in 2020. DID analyses revealed that after adjusting for prepandemic secular trends, the reductions in inpatient, ED, and outpatient visit rates in the early days of the pandemic were 1.6, 8.9, and 367.2 visits per 100 person-years (P<.001), respectively, while the increase in telehealth visits was 272.9 visits per 100 person-years (P<.001). Further analyses suggested that the increase in telehealth visits offset the reduction in outpatient visits by week 26 (June 28, 2020). CONCLUSIONS: In-person health care utilization decreased drastically during the early period of the pandemic, but there was a corresponding increase in telehealth visits during the same period. By end-June 2020, the combined outpatient and telehealth visits had recovered to prepandemic levels.


Asunto(s)
COVID-19/epidemiología , Prestación Integrada de Atención de Salud/estadística & datos numéricos , Servicio de Urgencia en Hospital/estadística & datos numéricos , Pacientes Internos/estadística & datos numéricos , Pacientes Ambulatorios/estadística & datos numéricos , Pandemias , Aceptación de la Atención de Salud/estadística & datos numéricos , Telemedicina/estadística & datos numéricos , Adolescente , Adulto , Anciano , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , SARS-CoV-2 , Adulto Joven
18.
Matern Child Health J ; 25(7): 1057-1068, 2021 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-33929653

RESUMEN

OBJECTIVE: Pregnancy and postpartum periods require continuity in care and counseling. During the pandemic process, telemedicine and telenursing applications have been used to meet the need for healthcare throughout the world, and skills in this area have been developed. This study aimed to identify the use of mobile applications by pregnant women in receiving health information, counseling, and healthcare during the COVID-19 pandemic and their distress levels during pregnancy. METHODS: This research was a descriptive cross-sectional study. The study was designed as an online survey administered between August 2020 and November 2020 via a questionnaire and the Tilburg Pregnancy Distress Scale (TPDS). A total of 376 women agreed to participate in the study. Women were included if they were literate, had a gestational age of ≥ 12th weeks, and accommodated within the Republic of Turkey's boundaries. RESULTS: A total of 77.9% of participants reported using pregnancy-related mobile applications during the pandemic. The mean total Tilburg Pregnancy Distress Scale score was 24.09, and 37.2% of the participants were found to be at risk for high distress according to the cut-off point. There was a significant difference between the change in receiving health services and the anxiety about coronavirus transmission and the Tilburg Pregnancy Distress Scale total score. (p ≤ 0.05). CONCLUSIONS: This study helped understand the pandemic's impact on pregnancy distress and usage of mobile health applications by pregnant women during the pandemic. Also, our results indicate that a decrease in pregnant women receiving health services during this period. Mobile health applications appear to be usable for prenatal follow-ups because mobile applications are common among pregnant women during the COVID-19 pandemic.


Asunto(s)
COVID-19/epidemiología , Servicios de Salud Materna , Aplicaciones Móviles/estadística & datos numéricos , Distrés Psicológico , Telemedicina/métodos , Adolescente , Adulto , COVID-19/psicología , Estudios Transversales , Escolaridad , Femenino , Humanos , Servicios de Salud Materna/estadística & datos numéricos , Persona de Mediana Edad , Embarazo/psicología , Encuestas y Cuestionarios , Telemedicina/estadística & datos numéricos , Turquia/epidemiología , Adulto Joven
19.
J Psychosoc Oncol ; 39(3): 416-427, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33792503

RESUMEN

BACKGROUND: The novel coronavirus (COVID-19) rapidly shifted psychosocial services to telepsychology, including psychosocial oncology (PSO) practices. PSO providers work with patients undergoing treatment, experiencing treatment delays and/or immuno-suppression in the context of a global pandemic. There is evidence to support the acceptability of telepsychology among cancer patients and an emerging need for data to inform the design and provision of telepsychology PSO care during the pandemic and beyond. RESEARCH OBJECTIVES: This study examined engagement in telepsychology PSO care at an outpatient community cancer center. METHODS: The current study analyzed practice data from a PSO department from March 2020 through September 2020. The sample included 354 patients (91 established; 263 newly referred). Descriptive, correlational, and comparative analyses were conducted. RESULTS: Among established patients, 93% continued with telepsychology PSO care after the pandemic and 94% completed at least one telepsychology appointment. Among newly referred patients, 50.6% scheduled a telepsychology appointment, consistent with the scheduling rate for the proceeding calendar year (50%). Across patients scheduling telepsychology PSO appointments (N = 194), 68 initially engaged in phone-based services with 20 converting to video, for a total of 127 (76.5%) patients utilizing video-based PSO services. Common reasons for phone-based services included 'patient preference' (N = 14), 'lack of access' (N = 9), and 'technology barriers' (N = 8). During this timeframe, 18% had at least one no-show, which is significantly less than the preceding year (23%). Phone-based patients were significantly older (p =.007). A greater proportion of males engaged in phone-based services compared to females (p = .006). CONCLUSIONS: Telepsychology PSO engages new and existing patients during the COVID-19 pandemic. There may be an increased demand for services and increased utilization in the context of the pandemic and the availability of telepsychology. There are disparities and access issues that should be considered and addressed.


Asunto(s)
COVID-19 , Utilización de Instalaciones y Servicios/estadística & datos numéricos , Neoplasias/psicología , Neoplasias/rehabilitación , Intervención Psicosocial/estadística & datos numéricos , Telemedicina/estadística & datos numéricos , Atención Ambulatoria/estadística & datos numéricos , Servicios de Salud Comunitaria/estadística & datos numéricos , Femenino , Humanos , Intervención basada en la Internet/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Psicooncología/estadística & datos numéricos , Derivación y Consulta/estadística & datos numéricos , Estudios Retrospectivos , Teléfono/estadística & datos numéricos
20.
JAMA Netw Open ; 4(4): e215854, 2021 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-33852002

RESUMEN

Importance: Ensuring access to prenatal care services in the US is challenging, and implementation of telehealth options was limited before the COVID-19 pandemic, especially in vulnerable populations, given the regulatory requirements for video visit technology. Objective: To explore the association of audio-only virtual prenatal care with perinatal outcomes. Design, Setting, and Participants: This cohort study compared perinatal outcomes of women who delivered between May 1 and October 31, 2019 (n = 6559), and received in-person prenatal visits only with those who delivered between May 1 and October 31, 2020 (n = 6048), when audio-only virtual visits were integrated into prenatal care during the COVID-19 pandemic, as feasible based on pregnancy complications. Parkland Health and Hospital System in Dallas, Texas, provides care to the vulnerable obstetric population of the county via a high-volume prenatal clinic system and public maternity hospital. All deliveries of infants weighing more than 500 g, whether live or stillborn, were included. Exposures: Prenatal care incorporating audio-only prenatal care visits. Main Outcomes and Measures: The primary outcome was a composite of placental abruption, stillbirth, neonatal intensive care unit admission in a full-term (≥37 weeks) infant, and umbilical cord blood pH less than 7.0. Visit data, maternal characteristics, and other perinatal outcomes were also examined. Results: The mean (SD) age of the 6559 women who delivered in 2019 was 27.8 (6.4) years, and the age of the 6048 women who delivered in 2020 was 27.7 (6.5) years (P = .38). Of women delivering in 2020, 1090 (18.0%) were non-Hispanic Black compared with 1067 (16.3%) in 2019 (P = .04). In the 2020 cohort, 4067 women (67.2%) attended at least 1 and 1216 women (20.1%) attended at least 3 audio-only virtual prenatal visits. Women who delivered in 2020 attended a greater mean (SD) number of prenatal visits compared with women who delivered in 2019 (9.8 [3.4] vs 9.4 [3.8] visits; P < .001). In the 2020 cohort, 173 women (2.9%) experienced the composite outcome, which was not significantly different than the 195 women (3.0%) in 2019 (P = .71). In addition, the rate of the composite outcome did not differ substantially when examined according to the number of audio-only virtual visits attended. Conclusions and Relevance: Implementation of audio-only virtual prenatal visits was not associated with changes in perinatal outcomes and increased prenatal visit attendance in a vulnerable population during the COVID-19 pandemic when used in a risk-appropriate model.


Asunto(s)
Atención Ambulatoria/estadística & datos numéricos , COVID-19 , Parto Obstétrico/estadística & datos numéricos , Atención Prenatal/estadística & datos numéricos , Telemedicina/estadística & datos numéricos , Adulto , Femenino , Humanos , Embarazo , Complicaciones del Embarazo/epidemiología , Resultado del Embarazo , Atención Prenatal/métodos , SARS-CoV-2 , Texas/epidemiología
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