No abstract

Background: Telehealth has evolved as a solution to COVID-19 isolation precautions and remote care with well-established health, socioeconomic, and practical benefits. However, there are many gaps in the current literature regarding telehealth use among older, low health literate, and resource-limited populations. There are ethical considerations that warrant understanding this digital divide. Objective: The objective of this review is to propose the Telehealth Literacy Screening Tool (TLST) for use in older adults and support the future inclusion of telehealth literacy as an important social determinant of health (SDOH). Methods: Initially a four-week outreach was performed that targeted older adults and low-health literate patients at the MedVantage Clinic (MVC) within Ochsner Health (OH) to identify common barriers to patient engagement with the OH Epic MyChart telehealth platform. Themes from those barriers directed a meta-synthetic review of the methods and ethical considerations of current, validated technological and telehealth literacy screening tools. Those findings were reported based on the standards of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. Results: Based on the barriers identified during our MVC patient outreach, PRISMA-reported review of telehealth literacy screening research, and evaluation of the MyChart platform and the technological resources required for its use; we developed a multidimensional questionnaire for telehealth literacy screening of older adults. Conclusion: The TLST is designed to identify patients in need of additional interventions for successful connection to telehealth services. This is an important step towards addressing the ethical obligation to decrease disparities in telehealth literacy for vulnerable populations and identifying telehealth literacy as a SDOH.

In New Orleans, Louisiana, 61% of advanced age patients have low health literacy, 50% report financial insecurity, and more than one-third have high hospital readmission rates and medical complexity scores. This population has been disproportionately impacted by the COVID-19 pandemic and the system-wide transition to remote, virtual visits. While COVID-19 has accelerated needs for impactful remote care and research, this has been impeded by low telehealth literacy and structural barriers, such as lack of internet and devices. There are major gaps in the literature regarding telemedicine services in geriatric and complex populations and efficacy rates are variable in these populations. There is currently no telehealth literacy screening tool designed for identifying patients with barriers requiring additional interventions to succeed, no uniform understanding of the factors affecting use or how to increase engagement, and telehealth models requiring fluent use of technology for older adults have been met with poor rates of completed visits and associated harm. Following a dedicated 358.5 hours to training 309 geriatric, complex patients in telemedicine using our pre-existing telehealth model, averaging 4.78 hours per patient, only 18.8% of these patients were subsequently able to connect to the provider virtually. Here we describe lessons learned and tools developed from the Ochsner MedVantage Network Innovation project, including the development of a telehealth literacy screening tool, the adaptation and provision of simplified, user-friendly tablets, and a randomized control trial to determine if increased accessibility to telehealth leads to improved healthcare outcomes, such as decreased hospital admissions and emergency department utilization.

Chronic exertional compartment syndrome (CECS) is a commonly missed diagnosis. It is caused by an increase in intramuscular pressure which subsequently impedes local tissue perfusion and function. It disproportionately occurs in young females; however, the diagnosis should not be excluded in other demographics. We present a case of CECS in an otherwise healthy 53-year-old male fire captain. He presented with pain upon exertion and neurological deficits in the anterior compartment of his bilateral legs that impacted his occupation and daily functioning. Following fasciotomy, the patient returned to work with complete resolution of pain and neurological deficits. This review seeks to describe the prevalence, etiology, diagnostic criteria, differential diagnosis, and management of CECS of the lower extremities, as described in the literature.