Telemedicine journal and e-health : the official journal of the American Telemedicine Association最新文献

{"title":"Home Low Vision Ocular Rehabilitation Telehealth Expansion Due to COVID-19 Pandemic.","authors":"Carolyn Ihrig","doi":"10.1089/tmj.2021.0264","DOIUrl":"https://doi.org/10.1089/tmj.2021.0264","url":null,"abstract":"<p><p>\u0000 <b>\u0000 <i>Background:</i>\u0000 </b>\u0000 <i>In March 2020, the pandemic added a major barrier resulting in the cancelation of all low vision ocular rehabilitation services. To prevent delay of beginning low vision ocular rehabilitation services, all low vision care was switched to telerehabilitation to home.</i>\u0000 <b>\u0000 <i>Methods:</i>\u0000 </b>\u0000 <i>Case managers began to cancel all in-person services and offer Veterans Affairs (VA) video connect services to their home. Patients with video access scheduled a home VA video connect telerehabilitation evaluation and therapy assessment. Patients who did not have video access waited to schedule a future in-person low vision appointment (postpandemic).</i>\u0000 <b>\u0000 <i>Results:</i>\u0000 </b>\u0000 <i>Of the in-person canceled appointments, 54% who scheduled the new home telerehabilitation evaluation were delayed on average 25 calendar days. Patients who waited for in-person low vision care were delayed on average 98, 138, or 153 calendar days. Of the 56 new patients referred for low vision optometry services during this 4-month period (COVID-19), 91% scheduled home low vision ocular telerehabilitation evaluations without delay; 5% waited until in-person clinics were open; and 4% waited until rural VA's and community-based outpatient centers were open.</i>\u0000 <b>\u0000 <i>Discussion:</i>\u0000 </b>\u0000 <i>Veterans with low vision who live in rural communities have limited access to services unless they are able to travel several miles to a specialty low vision clinic. Low vision ocular rehabilitation telehealth services have been successfully provided at the VA Western New York Healthcare System (Buffalo, NY) low vision clinic.</i>\u0000 <b>\u0000 <i>Conclusions:</i>\u0000 </b>\u0000 <i>Home low vision ocular rehabilitation telehealth increases access as early as possible once diagnosed with ocular pathology resulting in low vision.</i>\u0000 </p>","PeriodicalId":520784,"journal":{"name":"Telemedicine journal and e-health : the official journal of the American Telemedicine Association","volume":" ","pages":"873-877"},"PeriodicalIF":4.7,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39445353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Telehealth Services in Children with Cystic Fibrosis During Coronavirus Disease 2019 Outbreak.","authors":"Ömer Faruk Beşer,&nbsp;Ebru Pelin Uğur Karaboğa,&nbsp;Evrim Hepkaya,&nbsp;Ayşe Ayzıt Kılınç Sakallı,&nbsp;Ahsen Dönmez Türkmen,&nbsp;Tuğçe Damla Dilek,&nbsp;Haluk Çokuğraş,&nbsp;Fügen Çullu Çokuğraş","doi":"10.1089/tmj.2021.0228","DOIUrl":"https://doi.org/10.1089/tmj.2021.0228","url":null,"abstract":"<p><p><b><i>Objectives:</i></b><i>This study aimed to monitor the health and nutritional status of pediatric cystic fibrosis (CF) patients via telehealth services during the novel coronavirus disease 2019 (COVID-19). Additional aims were to determine the level of anxiety in the patients and their caregivers and to determine the COVID-19 transmission status among CF patients.</i><b><i>Materials and Methods:</i></b><i>The CF team supported the patients via remote contact. During telehealth services interviews, in addition to obtaining information about the patients' anthropometric measurements, health status, and CF-related complaints, the State-Trait Anxiety Inventory (STAI) was administered to the patients and controls. The Hospital Anxiety and Depression Scale (HAD) was administered to their caregivers.</i><b><i>Results:</i></b><i>The study included 144 pediatric CF patients (74 males and 70 females). Mean age of the patients was 8.9 years. In all, 42 (29.2%) of the patients were tested for COVID-19, of which 4 were positive. The mean STAI score was significantly lower in the patient group than in the control group (</i>p <i>< 0.001). The mean HAD anxiety score was significantly higher in the caregivers of the CF patients, compared to the caregivers of the controls (</i>p<i> = 0.005). In addition, the mean HAD depression score was significantly higher in the caregivers of the CF patients (</i>p <i>< 0.001).</i><b><i>Conclusions:</i></b><i>Telehealth is an innovative method for providing health care services while maintaining social distance and avoiding the risk of exposure and spread of COVID-19. Telehealth services reduce patient and parental anxiety and increase the level of confidence in managing CF-related complications.</i></p>","PeriodicalId":520784,"journal":{"name":"Telemedicine journal and e-health : the official journal of the American Telemedicine Association","volume":" ","pages":"832-837"},"PeriodicalIF":4.7,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39493987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of Mobile Application for Assessment of Basic Echocardiographic Parameters in Apparently Healthy Population.","authors":"Irina V Pospelova,&nbsp;Dmitry S Bragin,&nbsp;Irina V Cherepanova,&nbsp;Victoriya N Serebryakova,&nbsp;Alexander A Sokolov,&nbsp;Vladimir S Kaveshnikov","doi":"10.1089/tmj.2021.0302","DOIUrl":"https://doi.org/10.1089/tmj.2021.0302","url":null,"abstract":"<p><p>\u0000 <b>\u0000 <i>Background:</i>\u0000 </b>\u0000 <i>Development of tools, making for easier assessment of the age- and body size-specific echocardiographic parameters in the general population, becomes increasingly important.</i>\u0000 <b>\u0000 <i>Materials and Methods:</i>\u0000 </b>\u0000 <i>The application was developed on the basis of the previously designed model of normal values for basic echocardiographic parameters. The source population for the normal values was 10,604 apparently healthy people aged from 1 day to 65 years old, in which optimal visualization of the heart in the parasternal and apical echocardiographic views could be obtained. The whole population surveyed was categorized into three age groups. The predicted parameters were calculated by the group-specific regression equations. Deviation from the norm for one or another echocardiographic parameter was determined based on the value of z-score.</i>\u0000 <b>\u0000 <i>Results:</i>\u0000 </b>\u0000 <i>The mobile application was designed for the medical community and allows for a selective assessment of basic echocardiographic parameters in apparently healthy people with high accuracy. The application has a friendly graphical interface and provides color output on display of the results obtained.</i>\u0000 <b>\u0000 <i>Discussion:</i>\u0000 </b>\u0000 <i>The value of this application is in its uniqueness, since having analyzed available scientific works on mobile applications in medicine we could hardly find similar developments.</i>\u0000 <b>\u0000 <i>Conclusions:</i>\u0000 </b>\u0000 <i>Using the mobile application can save a doctor's time by simplifying the process of entering initial data, automating calculations, and providing convenient displaying of results. From this perspective, the application developed can become a useful tool in the sphere of telemedicine, in particular-the mobile medicine for remote consultation of patients.</i>\u0000 </p>","PeriodicalId":520784,"journal":{"name":"Telemedicine journal and e-health : the official journal of the American Telemedicine Association","volume":" ","pages":"815-822"},"PeriodicalIF":4.7,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39558540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Criteria-Based Assessment of a Teleophthalmology Diabetic Retinopathy Evaluation Program in a Primary Care Setting.","authors":"Samuel Leeman,&nbsp;Lu Wang,&nbsp;Brent A Johnson,&nbsp;Robert J Fortuna,&nbsp;Rajeev S Ramchandran","doi":"10.1089/tmj.2021.0064","DOIUrl":"https://doi.org/10.1089/tmj.2021.0064","url":null,"abstract":"<p><p><b><i>Background:</i></b><i>Studies have shown that teleophthalmology programs using a nonmydriatic camera in primary care settings can improve rates of diabetic retinopathy (DR) screening. However, such programs are not yet widespread due to common challenges in sustainability.</i><b><i>Purpose:</i></b><i>To comprehensively evaluate clinical and operational measures of an urban primary care clinic's 1-year pilot teleophthalmology DR evaluation program.</i><b><i>Materials and Methods:</i></b><i>This retrospective analysis used five metrics to evaluate the program: clinical diabetic retinal exam (DRE) rate, visual acuity and pathology, camera utilization, billing and insurance reimbursements, and outcomes of follow-up referrals.</i><b><i>Results:</i></b><i>Two hundred eleven patients were screened over 14 months. The DRE rate had more than doubled (34-75%). Of the patients, 55.9% had vision better than 20/50 in each eye and 21% with at least 1 eye worse than or equal to 20/70. DR was noted in 11% of patients. The program's first few months saw greatest camera use. Government and Medicare Advantage insurers were significantly (</i>p <i>< 0.001) less likely to reimburse than commercial insurers. Twenty-seven percent of patients screened had documented follow-up with an eye care provider within 16 months of their screening. Patients diagnosed with DR or recommended follow-up within 1 month were significantly (</i>p <i>< 0.001) more likely to schedule an appointment.</i><b><i>Discussion:</i></b><i>Challenges to program sustainability include efficient utilization, reimbursement from governmental insurers, and adherence to follow-up recommendations.</i><b><i>Conclusions:</i></b><i>Assessing teleophthalmology programs with the aforementioned five metrics allows for a comprehensive evaluation of impact and sustainability. This may be utilized to standardize the implementation and evaluation of such programs across diverse settings.</i></p>","PeriodicalId":520784,"journal":{"name":"Telemedicine journal and e-health : the official journal of the American Telemedicine Association","volume":" ","pages":"865-872"},"PeriodicalIF":4.7,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39631866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current Surgical Trainee Perceptions and Experiences in Telehealth.","authors":"Emaad J Iqbal,&nbsp;Thomas Sutton,&nbsp;Mudassir S Akther,&nbsp;Ashraf Samhan,&nbsp;Stephanie MacDonald,&nbsp;Julia R Coleman,&nbsp;Patricia L Turner,&nbsp;Vahagn C Nikolian","doi":"10.1089/tmj.2021.0237","DOIUrl":"https://doi.org/10.1089/tmj.2021.0237","url":null,"abstract":"<p><p><b><i>Introduction:</i></b><i>Broad expansion of telehealth technologies has been implemented during the coronavirus disease 2019 (COVID-19) pandemic to allow for physical distancing and limitation of viral transmission within health care facilities. Although telehealth has been studied for its impact on patients, payors, and practitioners, its educational impact is largely unstudied. To better understand the trainee experience and perception of telehealth during the COVID-19 pandemic, we conducted a survey of the membership of the American College of Surgeons Resident and Associate Society (RAS).</i><b><i>Methods:</i></b><i>An anonymous survey was sent to members of RAS. Descriptive analysis was used to report experiences and perceptions. Chi-square analysis was used to compare cohorts with and without exposure to telehealth.</i><b><i>Results:</i></b><i>Of the 465 RAS respondents, 292 (62.8%) reported knowledge of telehealth technologies at their institutions. The majority of these respondents experienced a decrease in in-person clinic volume (94.4%) and an associated increase in virtual clinic volume (95.7%) related to the COVID-19 pandemic. Trainee integration into telehealth workflows increased drastically from prepandemic levels (11% vs. 54.5%,</i> p <i>< 0.001). Likelihood of trainee exposure to telehealth was associated with university-based training programs or larger program size. Trainees demonstrated a desire for more integration and development of curricula.</i><b><i>Conclusions:</i></b><i>These data serve as the first description of surgical trainee experience with, and opinion of, telehealth. Trainees recognize the importance of their integration and training in telehealth. These results should be used to guide the development of workflows and curricula that integrate trainees into telemedicine clinics.</i></p>","PeriodicalId":520784,"journal":{"name":"Telemedicine journal and e-health : the official journal of the American Telemedicine Association","volume":" ","pages":"789-797"},"PeriodicalIF":4.7,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39508262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Tele-Coaching During the COVID-19 Pandemic on Risk-Reduction Behavior of Patients with Heart Failure.","authors":"Katharina Knoll,&nbsp;Sarah M Leiter,&nbsp;Stefanie Rosner,&nbsp;Teresa Trenkwalder,&nbsp;Amadea Erben,&nbsp;Christian Kloss,&nbsp;Patrick Bregenhorn,&nbsp;Heribert Schunkert,&nbsp;Wibke Reinhard","doi":"10.1089/tmj.2021.0324","DOIUrl":"https://doi.org/10.1089/tmj.2021.0324","url":null,"abstract":"<p><p><b>Introduction:</b> Our study assessed the effectiveness of tele-coaching over written information in educating patients with chronic heart failure (CHF) at high risk of hospitalization about corona virus disease 2019 (COVID-19). We analyzed the impact on number of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections and self-reported behavior change. <b>Methods:</b> In April 2020, a tele-coaching module and written summary about COVID-19, risk-reduction measures for prevention of COVID-19, and appropriate consultation of medical attention during the pandemic were integrated into an established tele-coaching program. Three hundred seventy-eight patients who had received both tele-coaching and written information 3 weeks earlier were interviewed using a structured questionnaire and compared with 1,748 patients who had only received written information at this point. <b>Results:</b> Tele-coaching had no short-term effect on numbers of SARS-CoV-2 infections. However, patients receiving tele-coaching reported significantly more behavioral changes, including increased room ventilation (88% vs. 78%, <i>p</i> < 0.0001), surface cleaning (80% vs. 70%, <i>p</i> = 0.0006), wearing of face masks (59% vs. 51%, <i>p</i> = 0.013), and reduced usage of public transport (77% vs. 68%, <i>p</i> = 0.0003), despite no observed difference in recall about risk-reduction measures. Moreover, tele-coaching improved patients' knowledge about how to seek medical help in an emergency (46% vs. 36%, <i>p</i> = 0.0006), with a significant reduction in self-reported doctors' appointments (304 vs. 413 per 1,000 patients, <i>p</i> = 0.002) and hospital visits (50 vs. 87 per 1,000, <i>p</i> = 0.033) during the first peak of the pandemic. <b>Conclusion:</b> In a population of patients with CHF at high risk of hospitalization, COVID-19-specific tele-coaching effectively supported behavioral changes and significantly reduced face-to-face medical contacts in a short-term follow-up period.</p>","PeriodicalId":520784,"journal":{"name":"Telemedicine journal and e-health : the official journal of the American Telemedicine Association","volume":" ","pages":"823-831"},"PeriodicalIF":4.7,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39493920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship Between Efficiency, Effectiveness, and Learnability of Home Connected Medical Device in Ambulatory Surgery.","authors":"Noémie Chaniaud,&nbsp;Camille Sagnier,&nbsp;Olga Megalakaki,&nbsp;Emilie Loup-Escande","doi":"10.1089/tmj.2021.0233","DOIUrl":"https://doi.org/10.1089/tmj.2021.0233","url":null,"abstract":"<p><p><b><i>Background:</i></b><i>Currently, usability assessments of home connected medical devices do not systematically take into account</i> learnability <i>metrics. In case of the</i> Smart Angel <i>device</i>-<i>designed for monitoring ambulatory surgery patients</i>-<i>users are trained at the hospital and have to use the device at home to monitor their health remotely</i>. <b><i>Objective:</i></b><i>The aim of this study was to better understand the relationships between two metrics of usability</i>-efficiency <i>and</i> effectiveness-<i>and</i> learnability <i>of the</i> Smart Angel <i>device</i>. <b><i>Materials and Methods:</i></b><i>Twenty-eight participants were trained in a simulated hospital (</i>SimUsanté<i>), and then we filmed the participant using the device three times. Between each session, the participant had to complete questionnaires (sociodemographic and health literacy)</i>. <b><i>Results:</i></b><i>The results of a between-subject analysis [χ²(2) = 18.969,</i> p <i>< 0.001] and a within-subject analysis [</i>F<i>(2.28) = 13.34,</i> p <i>< 0.001,</i> η^<i>2</i><i> = 0.35] showed that</i> efficiency <i>(manipulation time) significantly improved with</i> learnability <i>(number of sessions). Conversely,</i> effectiveness <i>(number of manipulation errors) stagnated over the three sessions with a between-subject analysis</i> [F<i>(2.75) = 1.628,</i> p<i> = 0.203], while the within-subject analysis revealed that users seemed to significantly correct their errors with the number of sessions [</i>F<i>(2.28) = 6,</i> p<i> = 0.005,</i> η^<i>2</i><i> = 0.19]. By analyzing the errors, we observed that some errors could appear at any time (e.g., moving during the measurement) and others were systematic (e.g., the wrist blood pressure on the right arm).</i><b><i>Conclusions:</i></b><i>While the \"first attempt\" at using a home medical device is a major revealing step for the study of manipulation errors, learnability is an equally useful metric to include in usability studies, as well as in the very definition itself of usability.</i></p>","PeriodicalId":520784,"journal":{"name":"Telemedicine journal and e-health : the official journal of the American Telemedicine Association","volume":" ","pages":"904-911"},"PeriodicalIF":4.7,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39520082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health Care Disparities and Access to Video Visits Before and After the COVID-19 Pandemic: Findings from a Patient Survey in Primary Care.","authors":"Emily C Webber,&nbsp;Brock D McMillen,&nbsp;Deanna R Willis","doi":"10.1089/tmj.2021.0126","DOIUrl":"https://doi.org/10.1089/tmj.2021.0126","url":null,"abstract":"<p><p><b><i>Background:</i></b><i>In 2020, the Centers for Medicare & Medicaid Services reimbursement structure was relaxed to aid in the rapid adoption nationally of telemedicine during the COVID-19 pandemic. Due to limited access to internet service, cellular phone data, and appropriate devices, many patients may be excluded from telemedicine services.</i><b><i>Methods:</i></b><i>In this study, we present the findings of a survey of patients at an urban primary care clinic regarding their access to the tools needed for telemedicine before and after the COVID-19 pandemic. Patients provided information about their access to internet services, phone and data plans, and their perceived access to and interest in telemedicine. The survey was conducted in 2019 and then again in September of 2020 after expansion of telemedicine services.</i><b><i>Results:</i></b><i>In 2019, 168 patients were surveyed; and in 2020, 99 patients participated. In both surveys, 30% of respondents had limited phone data, no data, or no phone at all. In 2019, the patient responses showed a statistically significant difference in phone plan types between patients with different insurance plans (</i>p <i>< 0.10), with a higher proportion (39%) of patients with Medicaid or Medicaid waiver having a prepaid phone or no phone at all compared with patients with commercial insurance (26%). The overall awareness rate increased from 17% to 43% in the 2020 survey.</i><b><i>Conclusions:</i></b><i>This survey illustrated that not all patients had access to devices, cellular data, and internet service, which are all needed to conduct telemedicine. In this survey, patients with Medicaid or Medicaid waiver insurance were less likely to have these tools than those with a commercial payor. Finally, patients' access to these telemedicine tools correlated with their interest in using telemedicine visits. Providing equitable telemedicine care requires attention to and mitigation strategies for these gaps in access.</i></p>","PeriodicalId":520784,"journal":{"name":"Telemedicine journal and e-health : the official journal of the American Telemedicine Association","volume":" ","pages":"712-719"},"PeriodicalIF":4.7,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39357496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Telemedicine, Precision Medicine, and Regionalization.","authors":"Rashid L Bashshur,&nbsp;Mary J Bashshur,&nbsp;Elizabeth A Krupinski","doi":"10.1089/tmj.2021.0357","DOIUrl":"https://doi.org/10.1089/tmj.2021.0357","url":null,"abstract":"<p><p>\u0000 <i>The COVID-19 global pandemic dramatically spurred the implementation and use of telemedicine, but also highlighted some significant disparities and gaps in our health care systems. These include limited access to care among segments of the population, uneven distribution of quality by geographic location and socioeconomic status, unabated cost inflation, rampant inefficiency, and substantial incidence of medical errors, inappropriate or ineffective care. It is time we think about optimal systems of care to meet the challenges of the future.</i>\u0000 </p>","PeriodicalId":520784,"journal":{"name":"Telemedicine journal and e-health : the official journal of the American Telemedicine Association","volume":" ","pages":"599-601"},"PeriodicalIF":4.7,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39411467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Policy Facilitators Versus Structural Barriers: Integrative Therapy Telehealth Changes in the United States During the COVID-19 Pandemic.","authors":"Maya Scott-Richardson,&nbsp;Guinevere Johnson,&nbsp;Sianna Burnett,&nbsp;Nicholas A Giordano,&nbsp;Krista B Highland","doi":"10.1089/tmj.2021.0167","DOIUrl":"https://doi.org/10.1089/tmj.2021.0167","url":null,"abstract":"<p><p>\u0000 <b>\u0000 <i>Introduction:</i>\u0000 </b>\u0000 <i>Complementary and integrative therapies such as physical therapy (PT) and occupational therapy (OT) have been shown to improve functional outcomes and reduce opioid use. Due to the COVID-19 (or SARS-CoV-2 [severe acute respiratory syndrome coronavirus 2]) pandemic, these therapies are switching to telehealth and telemedicine practices, but access and utilization may be limited due to state policies and social vulnerability.</i>\u0000 <b>\u0000 <i>Objective:</i>\u0000 </b>\u0000 <i>The objective of this cross-sectional analysis was to evaluate the policy changes to telehealth provisions during the pandemic and the degree to which structural barriers could stymie the intended impact of these policies (e.g., PT/OT accessibility).</i>\u0000 <b>\u0000 <i>Materials and Methods:</i>\u0000 </b>\u0000 <i>Our analysis examined each states' telehealth policies in relation to PT/OT, ranked their telehealth readiness, identified relationships between existing policies and opioid prescription rates, and discussed how social determinants of health may be associated with telehealth availability and accessibility.</i>\u0000 <b>\u0000 <i>Results:</i>\u0000 </b>\u0000 <i>Approximately two of five states have both telehealth and telemedicine policies, whereas the majority of states had either a PT- or OT-specific policy in place. In addition, almost all states and the District of Columbia (90%) had general telehealth/medicine policy changes as a result of the pandemic.</i>\u0000 <b>\u0000 <i>Discussion:</i>\u0000 </b>\u0000 <i>Although such policy changes could reduce COVID-19-related barriers, the degree to which these policies can have a large and long-lasting impact may be contingent on structural barriers. Many states that lack broadband access and have high social vulnerability need more improvements to ensure the utilization of telehealth care, including PT and OT.</i>\u0000 <b>\u0000 <i>Conclusion:</i>\u0000 </b>\u0000 <i>Despite the policies expanding PT/OT telehealth capabilities, structural barriers may further exacerbate inequities in care accessibility.</i>\u0000 </p>","PeriodicalId":520784,"journal":{"name":"Telemedicine journal and e-health : the official journal of the American Telemedicine Association","volume":" ","pages":"728-735"},"PeriodicalIF":4.7,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39416110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}