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1.
Cien Saude Colet ; 26(6): 2149-2157, 2021 Jun.
Artigo em Português, Inglês | MEDLINE | ID: mdl-34231727

RESUMO

SARS-CoV-2, the virus that causes Covid-19, is the third coronavirus to cause severe disease in humans and to spread globally in the past two decades. In this context, several national public health departments, including the Brazilian Ministry of Health, highlighted what was, until then, considered a support service to the health system: telehealth and telemedicine. We intend to present the actions carried out by a national telehealth service in Brazil, both as a Primary Health Care (PHC) support service to professionals and to patients, as well as discussing the potential to reorganize a health system. This is a prevalence study that summarizes the measures adopted by Brazilian Telehealth Center from the 9th to the 27th epidemiological weeks of 2020 to support the health services of the Brazilian Unified Health System (SUS). There was an increase of 76.8% in the demand for telephone teleconsultations during the evaluated period compared to the same period in 2019, with 28.8% of the entire demand arising from doubts related to Covid-19. The Covid-19 pandemic demanded a quick response, with the organization of materials about the disease, a new team to carry out telemonitoring and teleconsultation activities, in addition to the creation of a manual for teleconsultations in Primary Health Care.


Assuntos
COVID-19 , Telemedicina , Brasil/epidemiologia , Humanos , Pandemias , SARS-CoV-2
2.
Artigo em Inglês | MEDLINE | ID: mdl-34208194

RESUMO

In 2020, Taiwan's healthcare system faced a notable burden imposed by the coronavirus disease (COVID-19) pandemic. Emergency department (ED) is a high-risk area for severe acute respiratory syndrome coronavirus 2 transmission. The effect of COVID-19 on the utilization of ED services among frequent ED users remains unknown. This cohort study determined the impact of the COVID-19 pandemic on healthcare-seeking behaviors among frequent ED users at Taipei City Hospital, Taiwan. We included ED users aged ≥ 18 years admitted to Taipei City Hospital during February 2019-January 2020 (before the pandemic) and February 2020-January 2021 (during the pandemic). Frequent ED users were patients with four or more ED visits per year. Stepwise logistic regression was performed to identify predictors of frequent ED use during the COVID-19 pandemic. Frequent ED users had shorter hospital stays in the ED during the pandemic. After adjusting for sociodemographic factors and other covariates, patients with a triage status of level 4-5, pneumonia diagnosis, giddiness, or dyspnea were more likely frequent ED visitors during the COVID-19 pandemic. To reduce the risk of acquiring COVID-19, it is important to utilize territorial healthcare or telehealth to avoid inappropriate ED visits for patients with a low level of risk or chronic disease.


Assuntos
COVID-19 , Telemedicina , Estudos de Coortes , Serviço Hospitalar de Emergência , Humanos , Pandemias , Estudos Retrospectivos , SARS-CoV-2 , Taiwan/epidemiologia
3.
Prev Med ; 151: 106681, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34217422

RESUMO

The COVID-19 pandemic has contributed to decreases in breast, colorectal, and cervical cancer screenings between 86 and 94% compared to three-year averages. These postponed screenings have created backlogs that systems will need to address as healthcare facilities re-open for preventive care. The American Cancer Society is leading a 17-month intervention with 22 federally qualified health centers (FQHCs) across the United States aimed at reducing cancer incidence and mortality disparities and alleviating additional strain caused by COVID-19. This study describes COVID-related cancer screening service disruptions reported by participating FQHCs. Selected FQHCs experienced service disruptions and/or preventive care cancellations due to COVID-19 that varied in severity and duration. Fifty-nine percent stopped cancer screenings completely. Centers transitioned to telehealth visits or rescheduled for the future, but the impact of these strategies may be limited by continued pandemic-related disruptions and the inability to do most screenings at home; colon cancer screening being the exception. Most centers have resumed in-person screening, but limited in person appointments and high levels of community transmission may reduce FQHC abilities to provide catch-up services. FQHCs provide critical cancer prevention services to vulnerable populations. The delivery of culturally competent, high-quality healthcare can mitigate and potentially reverse racial and ethnic disparities in cancer prevention testing and treatment. Ensuring and expanding access to care as we move out of the pandemic will be critical to preventing excess cancer incidence and mortality in vulnerable populations.


Assuntos
COVID-19 , Neoplasias Colorretais , Telemedicina , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/prevenção & controle , Detecção Precoce de Câncer , Feminino , Humanos , Pandemias , Melhoria de Qualidade , SARS-CoV-2 , Estados Unidos
4.
Artigo em Inglês | MEDLINE | ID: mdl-34198917

RESUMO

BACKGROUND: Given the current COVID-19 pandemic situation, now more than ever, remote solutions for assessing and monitoring individuals with cognitive impairment are urgently needed. Older adults in particular, living in isolated rural areas or so-called 'medical deserts', are facing major difficulties in getting access to diagnosis and care. Telemedical approaches to assessments are promising and seem well accepted, reducing the burden of bringing patients to specialized clinics. However, many older adults are not yet adequately equipped to allow for proper implementation of this technology. A potential solution could be a mobile unit in the form of a van, equipped with the telemedical system which comes to the patients' home. The aim of this proof-of-concept study is to evaluate the feasibility and reliability of such mobile unit settings for remote cognitive testing. Methods and analysis: eight participants (aged between 69 and 86 years old) from the city of Digne-Les-Bains volunteered for this study. A basic neuropsychological assessment, including a short clinical interview, is administered in two conditions, by telemedicine in a mobile clinic (equipped van) at a participants' home and face to face in a specialized clinic. The administration procedure order is randomized, and the results are compared with each other. Acceptability and user experience are assessed among participants and clinicians in a qualitative and quantitative manner. Measurements of stress indicators were collected for comparison. RESULTS: The analysis revealed no significant differences in test results between the two administration procedures. Participants were, overall, very satisfied with the mobile clinic experience and found the use of the telemedical system relatively easy. CONCLUSION: A mobile unit equipped with a telemedical service could represent a solution for remote cognitive testing overcoming barriers in rural areas to access specialized diagnosis and care.


Assuntos
COVID-19 , Telemedicina , Idoso , Idoso de 80 Anos ou mais , Cognição , Estudos de Viabilidade , Humanos , Unidades Móveis de Saúde , Pandemias , Projetos Piloto , Reprodutibilidade dos Testes , SARS-CoV-2
5.
BMC Fam Pract ; 22(1): 143, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34210284

RESUMO

BACKGROUND: Integrated primary care teams are ideally positioned to support the mental health care needs arising during the COVID-19 pandemic. Understanding how COVID-19 has affected mental health care delivery within primary care settings will be critical to inform future policy and practice decisions during the later phases of the pandemic and beyond. The objective of our study was to describe the impact of the COVID-19 pandemic on primary care teams' delivery of mental health care. METHODS: A qualitative study using focus groups conducted with primary care teams in Ontario, Canada. Focus group data was analysed using thematic analysis. RESULTS: We conducted 11 focus groups with 10 primary care teams and a total of 48 participants. With respect to the impact of the COVID-19 pandemic on mental health care in primary care teams, we identified three key themes: i) the high demand for mental health care, ii) the rapid transformation to virtual care, and iii) the impact on providers. CONCLUSIONS: From the outset of the COVID-19 pandemic, primary care quickly responded to the rising mental health care demands of their patients. Despite the numerous challenges they faced with the rapid transition to virtual care, primary care teams have persevered. It is essential that policy and decision-makers take note of the toll that these demands have placed on providers. There is an immediate need to enhance primary care's capacity for mental health care for the duration of the pandemic and beyond.


Assuntos
COVID-19 , Prestação Integrada de Cuidados de Saúde/organização & administração , Serviços de Saúde Mental , Equipe de Assistência ao Paciente/organização & administração , Atenção Primária à Saúde , Telemedicina , Adulto , COVID-19/epidemiologia , COVID-19/prevenção & controle , COVID-19/psicologia , Feminino , Grupos Focais , Necessidades e Demandas de Serviços de Saúde , Humanos , Masculino , Saúde Mental/tendências , Serviços de Saúde Mental/normas , Serviços de Saúde Mental/provisão & distribuição , Ontário/epidemiologia , Padrões de Prática Médica/tendências , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/tendências , Melhoria de Qualidade/organização & administração , SARS-CoV-2 , Telemedicina/métodos , Telemedicina/estatística & dados numéricos
6.
J Anal Psychol ; 66(3): 517-533, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34231886

RESUMO

In this paper I discuss Jungian psychological work of the trauma and loss experienced in reaction to COVID-19 with a man who represents a clinical composite. The issues of precarity, a concept used by the philosopher Judith Butler, are combined with the notions of lack and absence of French psychoanalyst André Green. The psychological and societal situation of precarity aroused the man's childhood issues that were long repressed. The loneliness, isolation and death from COVID-19 mirrored his personal and the collective responses to the disaster from this global pandemic. He felt on the edge of collapse as what he knew of his world crashed and he found himself unable to cope. The subsequent Jungian work taking place through the virtual computer screen was taxing and restorative simultaneously for both analyst and analysand.


Assuntos
Experiências Adversas da Infância , COVID-19 , Teoria Junguiana , Solidão , Terapia Psicanalítica , Trauma Psicológico/terapia , Adulto , Ego , Humanos , Masculino , Telecomunicações , Telemedicina
7.
J Anal Psychol ; 66(3): 429-442, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34231889

RESUMO

This work originates from reflections on the observation of recurring themes in dreams of patients in psychoanalytic treatment during the most restrictive lockdown period in Italy (March - May 2020). The authors focus on the peculiar dialogic state between consciousness and the unconscious that arose following a collective event such as that of the pandemic, which determined the activation of complex personal nuclei, compensatory effects of the unconscious psyche and new perspective functions. These latter aspects are interpreted with reference to the contributions of Erich Neumann, bringing a new psychological vision of the relationship between Man and Nature in relation to catastrophic events.


Assuntos
COVID-19 , Sonhos , Distanciamento Físico , Interpretação Psicanalítica , Terapia Psicanalítica , Inconsciente Psicológico , Adulto , Humanos , Itália , Telemedicina
8.
J Anal Psychol ; 66(3): 463-483, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34231894

RESUMO

This paper explores the experience of working as a Jungian analyst through the various phases of the global COVID-19 pandemic, examining the importance of the physical containing space alongside the analyst's internal mind and how technology can both help and hinder understanding. A number of clinical vignettes illustrate the challenge of communicating over a distance, paying particular attention to the way countertransference phenomena can become re-attuned. Reference is made to mythology and symbols of hope, and consideration given to the meaning and purpose of the pandemic.


Assuntos
COVID-19 , Contratransferência , Distanciamento Físico , Relações Profissional-Paciente , Terapia Psicanalítica , Telemedicina , Adulto , Humanos , Teoria Junguiana
9.
J Anal Psychol ; 66(3): 534-545, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34231893

RESUMO

This paper explores the impact of the COVID-19 pandemic on my relationship with analysands and my inner world. I reflect on the role of the archetypal Self during times of existential anxiety that may lead to an experience of 'essential anxiety'. This term refers to a meeting by a fearful ego with an inward recognition of the Self, when faced with threat. The efforts to curb the spread of the pandemic changed our ways of life, while the virus itself threatened our existence in debilitating or outright destructive ways. But what also came into view, in sessions of analysis and supervision, was the creative instinct, and a celebration of life. The soul-to-soul relationship, and the connection with images of the archetypal Self, made the experience of existential anxiety at times an essential experience that facilitated psychological growth. I discuss some advantages of on-line Jungian analysis where, despite distance and partial view, the body still serves as container to hold important psychological material, conferring a sense of wholeness for analyst and analysand. The COVID-19 crisis is terrible and terrifying but it also provides an opportunity for self-regulation and individuation.


Assuntos
Ansiedade/psicologia , COVID-19 , Pessoal de Saúde/psicologia , Individuação , Relações Profissional-Paciente , Terapia Psicanalítica , Autocontrole , Adulto , Humanos , Teoria Junguiana , Suíça , Telemedicina
10.
J Anal Psychol ; 66(3): 605-619, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34231896

RESUMO

COVID-19, Black Lives Matter, and financial and political turmoil have uprooted our sense of personal and collective safety and predictability. Analysts are faced with professional and personal challenges, as well as a charge to help make sense of this new normal. This reflective piece focuses on the author's thoughts on a wounded and bleeding temenos. She grapples with the new reality of analysis carried out via technology (e.g. Zoom or telehealth). The article interweaves personal experiences with theoretical and professional reflections on two Jewish myths that relate to creating temenos or sacred space in the face of ancient disasters. Specifically, she discusses Choni HaMagel, a first-century BCE Jewish scholar and miracle-maker who prays for relief from a drought from inside a sacred circle. She also tells the tale of four Chassidic Rebbes who face crisis from a sacred space in the forest. The author frames this piece with two personal and numinous dreams dreamt during the pandemic; one offering scenes of destruction and one offering hope for a future transformation.


Assuntos
COVID-19 , Judaísmo , Religião e Psicologia , Adulto , Humanos , Terapia Psicanalítica , Telemedicina
11.
J Anal Psychol ; 66(3): 546-560, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34231895

RESUMO

COVID-19 has upended the way analysts and psychotherapists practice. Many use the phone for their sessions, many are using video platforms, and many use a combination of the two. Work with adolescents is very challenging in this new modality because of the loss of in-person connection and immediate non-verbal cues. The public health restrictions put in place to manage COVID-19 spread are at odds with the adolescent tasks of adventuring, experimenting and gaining new experiences. In addition, increased anxieties about infection, contamination and invasion are often manifest and adolescents can regress in the face of them. Using seminal ideas from Bion, this article looks at two process examples from adolescent boys who struggled with parts of themselves that felt disturbing and unacceptable. The author discusses the clinical exchanges in detail and offers ideas about the difficulty of creating psychic space when working virtually.


Assuntos
Adaptação Psicológica , Comportamento do Adolescente/psicologia , COVID-19 , Relações Profissional-Paciente , Terapia Psicanalítica , Telemedicina , Adolescente , Humanos , Masculino
12.
J Anal Psychol ; 66(3): 443-462, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34231900

RESUMO

This paper explores how the deadly shadow of COVID-19 passing over the Earth constitutes a collective trauma that frequently opens up or 'triggers' un-remembered personal trauma, and it provides clinical examples of these intersections. The paper further explores how the human imagination, which we normally utilize to make meaning out of traumatic experience, can be hijacked by fear - leading to avoidance of suffering and to illusory formulations and alternative realities such as conspiracy theories. Alternatively, the imagination can be employed in more realistic and creative ways - leading through conscious suffering to healing and wholeness. Which path the imagination takes is shown to depend on the capacity of individuals to feel the full reality of the human condition in general and the exquisite vulnerability of our existence as fragile human beings at this moment in history. Ernest Becker's analysis of our 'denial of death' and his urgency to embrace our common human vulnerability is explored in relation to Jung's early tendency to deny the body. The author proposes that the more creative uses of the imagination, connected to a more humble and realistic apprehension of our common destiny, may be seen in the 'Black Lives Matter' movement that swept the world in the aftermath of the COVID-19 outbreak.


Assuntos
COVID-19 , Medo/psicologia , Imaginação , Ativismo Político , Terapia Psicanalítica , Trauma Psicológico/psicologia , Racismo , Adulto , Humanos , Relações Profissional-Paciente , Telemedicina
13.
J Anal Psychol ; 66(3): 484-505, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34231903

RESUMO

Given the contemporary situation of many analysts in the world now being forced to work online due to the effects of the COVID-19 pandemic, it is important to review the working online issue. Substantial debate over previous years has questioned whether a genuine analytic process can unfold through online work. This debate is reviewed with the conclusion that such a process is not necessarily precluded. Research outcomes are then reviewed to highlight those things that can facilitate positive outcomes when working online. These cover the 'online disinhibition effect', the therapeutic alliance, particular ways of using the screen, focussing on trauma, the importance of self-awareness, knowing the predictors of mental health, certain potential positives of isolation/quarantine and psychotherapy interventions that may be currently needed. Final recommendations and suggestions are then presented as in the diagnosis issue, professional development and guidelines to do with practical and ethical considerations.


Assuntos
COVID-19 , Distanciamento Físico , Terapia Psicanalítica , Telecomunicações , Telemedicina , Aliança Terapêutica , Humanos , Terapia Psicanalítica/ética , Terapia Psicanalítica/normas , Telecomunicações/ética , Telecomunicações/normas , Telemedicina/ética , Telemedicina/normas
14.
J Anal Psychol ; 66(3): 379-398, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34231908

RESUMO

Most of the clinical experiences discussed in this article arose from monthly Zoom meetings at Rome's Italian Centre of Analytical Psychology (CIPA). We set up a discussion group in April 2020, one month after lockdown began in Italy, and these monthly online meetings continue to this day. All senior analysts and analysts-in-training at Rome's CIPA, whose backgrounds range from child and adolescent psychotherapy to adult psychotherapy and analysis, to sandplay therapy and medicine and psychiatry, have been participating in these meetings. The group discussions focus on the present time and its impact on us, as well as on our relationships with patients. By further developing these reflections during the lockdown in Italy (9 March - 3 May 2020), it is fair to ask whether a sense of unreality, depersonalization, or derealization has occurred, either in the therapist or patient, and if so, whether it is possible that therapists miss the human contact more than clients. We will mainly refer to clinical and personal experiences as our most precious guidelines.


Assuntos
COVID-19 , Narrativas Pessoais como Assunto , Distanciamento Físico , Relações Profissional-Paciente , Terapia Psicanalítica , Telemedicina , Adulto , Humanos , Pessoa de Meia-Idade , Cidade de Roma , Telecomunicações , Adulto Jovem
15.
BMC Health Serv Res ; 21(1): 675, 2021 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-34243772

RESUMO

BACKGROUND: Quantitative evidence suggests that interventions involving telephone calls and text message are feasible and effective for improving lifestyle intervention adherence and clinical outcomes among adults with obesity. The aim of this article is to provide qualitative insight into the perspectives and experiences of participants who completed a telehealth trial exploring the use of telephone and text support as adjunctive tools to support a community-based obesity management program. METHODS: Focus groups were conducted in order to evaluate program acceptability and overall participant perceptions of the clinical trial. Thematic content analysis was used to analyse the data, aided by the development of a thematic network. RESULTS: The telehealth trial was well received. Participants found the telephone and text message support highly beneficial, providing encouragement, motivation and accountability via a simple and convenient mode of communication. CONCLUSIONS: These findings suggest a high degree of promise for the incorporation of telephone and text support in obesity management.


Assuntos
Manejo da Obesidade , Telemedicina , Envio de Mensagens de Texto , Adulto , Humanos , Obesidade/prevenção & controle , Telefone
16.
Adv Gerontol ; 34(2): 251-257, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34245508

RESUMO

The article discusses perspectives of medical care in elderly and senile patients with cerebrovascular pathology with portable telemedical complex use. Analysis of telemedical cooperation physician-consultant-patient and discussion of medical equipment criteria for telemedical complex selection and organizational together with legal issues of medical data transfer, storage and access were performed. The important clinical features of cerebrovascular pathology in elderly patients were presented, which determined necessity of highly qualified medical specialist involvement in management of such patients. The opportunities of portable medical complex usage were discussed.


Assuntos
Telemedicina , Idoso , Humanos
17.
Artigo em Inglês | MEDLINE | ID: covidwho-1270036

RESUMO

In 2020, Taiwan's healthcare system faced a notable burden imposed by the coronavirus disease (COVID-19) pandemic. Emergency department (ED) is a high-risk area for severe acute respiratory syndrome coronavirus 2 transmission. The effect of COVID-19 on the utilization of ED services among frequent ED users remains unknown. This cohort study determined the impact of the COVID-19 pandemic on healthcare-seeking behaviors among frequent ED users at Taipei City Hospital, Taiwan. We included ED users aged ≥ 18 years admitted to Taipei City Hospital during February 2019-January 2020 (before the pandemic) and February 2020-January 2021 (during the pandemic). Frequent ED users were patients with four or more ED visits per year. Stepwise logistic regression was performed to identify predictors of frequent ED use during the COVID-19 pandemic. Frequent ED users had shorter hospital stays in the ED during the pandemic. After adjusting for sociodemographic factors and other covariates, patients with a triage status of level 4-5, pneumonia diagnosis, giddiness, or dyspnea were more likely frequent ED visitors during the COVID-19 pandemic. To reduce the risk of acquiring COVID-19, it is important to utilize territorial healthcare or telehealth to avoid inappropriate ED visits for patients with a low level of risk or chronic disease.


Assuntos
COVID-19 , Telemedicina , Estudos de Coortes , Serviço Hospitalar de Emergência , Humanos , Pandemias , Estudos Retrospectivos , SARS-CoV-2 , Taiwan/epidemiologia
18.
Artigo em Inglês | MEDLINE | ID: covidwho-1264442

RESUMO

BACKGROUND: Given the current COVID-19 pandemic situation, now more than ever, remote solutions for assessing and monitoring individuals with cognitive impairment are urgently needed. Older adults in particular, living in isolated rural areas or so-called 'medical deserts', are facing major difficulties in getting access to diagnosis and care. Telemedical approaches to assessments are promising and seem well accepted, reducing the burden of bringing patients to specialized clinics. However, many older adults are not yet adequately equipped to allow for proper implementation of this technology. A potential solution could be a mobile unit in the form of a van, equipped with the telemedical system which comes to the patients' home. The aim of this proof-of-concept study is to evaluate the feasibility and reliability of such mobile unit settings for remote cognitive testing. Methods and analysis: eight participants (aged between 69 and 86 years old) from the city of Digne-Les-Bains volunteered for this study. A basic neuropsychological assessment, including a short clinical interview, is administered in two conditions, by telemedicine in a mobile clinic (equipped van) at a participants' home and face to face in a specialized clinic. The administration procedure order is randomized, and the results are compared with each other. Acceptability and user experience are assessed among participants and clinicians in a qualitative and quantitative manner. Measurements of stress indicators were collected for comparison. RESULTS: The analysis revealed no significant differences in test results between the two administration procedures. Participants were, overall, very satisfied with the mobile clinic experience and found the use of the telemedical system relatively easy. CONCLUSION: A mobile unit equipped with a telemedical service could represent a solution for remote cognitive testing overcoming barriers in rural areas to access specialized diagnosis and care.


Assuntos
COVID-19 , Telemedicina , Idoso , Idoso de 80 Anos ou mais , Cognição , Estudos de Viabilidade , Humanos , Unidades Móveis de Saúde , Pandemias , Projetos Piloto , Reprodutibilidade dos Testes , SARS-CoV-2
19.
Eur J Pediatr ; 180(8): 2389-2400, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34196791

RESUMO

Children with medical complexity (CMC) are a high priority population with chronic illnesses dependent on the use of health services, on technological systems to support their vital functions and characterized by multiple health needs. One of the main challenges linked to chronic conditions is finding solutions to monitor CMC at home, avoiding re-hospitalization and the onset of complications. Telemedicine enables to remotely follow up patients and families. An integrative review was performed to assess whether telemedicine improves health outcomes for CMC. Medline/PubMed, CINAHL, Cochrane Library, Web of Science, and Scopus were searched to identify studies describing the effect of using telemedicine systems on health outcomes for CMC. The PRISMA guidelines were used to select the papers. The methodological quality of the studies was evaluated through the Johanna Briggs Institute critical appraisal tools and the Cochrane Collaboration ROB 2.0. A total of 17 papers met the quality criteria and were included. Specialized telemedicine systems (tele-visits), telehealth, and tele-monitoring have been reported to reduce unplanned hospitalizations and visits, decrease total costs for healthcare services and families, and increase satisfaction for family members. No effect was found on the quality of life in children and their families.Conclusion: Available evidence supporting the use of telemedicine in CMC is favorable but limited. High-quality methodological studies including other unexplored health outcomes such as mental health, hospital readmissions, mortality, caregiver competences, and self-efficacy are needed to confirm the effectiveness of telemedicine systems in improving health outcomes for CMC. What is Known: • CMC are an extremely fragile patient population with frequent access to healthcare services compared with other chronic conditions. • There is conflicting evidence of the effectiveness of telemedicine clinical outcomes, healthcare utilization, and costs in pediatrics. What is New: • There is some evidence that for CMC, telemedicine reduces unplanned hospitalizations, healthcare service costs, and financial burden for families, while increasing caregivers' satisfaction with care. • Further research is needed to confirm the effectiveness of telemedicine systems in improving health for CMC.


Assuntos
Qualidade de Vida , Telemedicina , Cuidadores , Criança , Doença Crônica , Humanos , Avaliação de Resultados em Cuidados de Saúde
20.
Prev Chronic Dis ; 18: E65, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34197284

RESUMO

INTRODUCTION: Telehealth plays a role in the continuum of care, especially for older adults during the COVID-19 pandemic. Our objective was to examine factors associated with the accessibility of telehealth services during the COVID-19 pandemic among older adults. METHODS: We analyzed the nationally representative Medicare Current Beneficiary Survey COVID-19 Rapid Response Supplement Questionnaire of beneficiaries aged 65 years or older. Two weighted multivariable logistic regression models were used to examine associations between usual providers who offered telehealth 1) during the COVID-19 pandemic and 2) to replace a regularly scheduled appointment. We examined factors including sociodemographic characteristics, comorbidities, and digital access and literacy. RESULTS: Of the beneficiaries (n = 6,172, weighted n = 32.4 million), 81.2% reported that their usual providers offered telehealth during the COVID-19 pandemic. Among those offered telehealth services, 56.8% reported that their usual providers offered telehealth to replace a regularly scheduled appointment. Disparities in accessibility of telehealth services by sex, residing area (metropolitan vs nonmetropolitan), income level, and US Census region were observed. Beneficiaries who reported having internet access (vs no access) (OR, 1.75, P < .001) and who reported ever having participated in video, voice, or conference calls over the internet before (vs not) (OR, 2.18, P < .001) were more likely to report having access to telehealth. Non-Hispanic Black beneficiaries (versus White) (OR, 1.57, P = .007) and beneficiaries with comorbidities (vs none) (eg, 2 or 3 comorbidities, OR, 1.25, 95% P = .044) were more likely to have their usual provider offer telehealth to replace a regularly scheduled appointment. CONCLUSION: Although accessibility of telehealth has increased, inequities raise concern. Educational outreach and training, such as installing and launching an online web conferencing platform, should be considered for improving accessibility of telehealth to vulnerable populations beyond the COVID-19 pandemic.


Assuntos
COVID-19 , Acesso aos Serviços de Saúde , Disparidades em Assistência à Saúde , Controle de Infecções/métodos , Medicare/estatística & dados numéricos , Telemedicina , Idoso , COVID-19/epidemiologia , COVID-19/prevenção & controle , Comorbidade , Estudos Transversais , Demografia , Feminino , Acesso aos Serviços de Saúde/normas , Acesso aos Serviços de Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/etnologia , Disparidades em Assistência à Saúde/organização & administração , Humanos , Acesso à Internet/estatística & dados numéricos , Masculino , Determinação de Necessidades de Cuidados de Saúde , SARS-CoV-2 , Fatores Socioeconômicos , Telemedicina/métodos , Telemedicina/organização & administração , Telemedicina/estatística & dados numéricos , Estados Unidos/epidemiologia
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