Advancing health equity and access using telemedicine: a geospatial assessment

Khairat, Saif; Haithcoat, Timothy L.; Liu, Songzi; Zaman, Tanzila; Edson, Barbara; Gianforcaro, Robert; Shyu, Chi‐Ren

doi:10.1093/jamia/ocz108

Cited by 122 publications

(92 citation statements)

References 48 publications

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“…For example, physicians could use patient-controlled devices to supply equipment normally available in offices [ 21 ], and marketing can be focused on groups with less access to care. It is noteworthy that telemedicine increased access to specialty care that previously could have been limited by geographic barriers [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

System-Wide Accelerated Implementation of Telemedicine in Response to COVID-19: Mixed Methods Evaluation

García-Huidobro¹,

Rivera²,

Chang³

et al. 2020

J Med Internet Res

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Background As the COVID-19 pandemic disrupted medical practice, telemedicine emerged as an alternative to outpatient visits. However, it is not known how patients and physicians responded to an accelerated implementation of this model of medical care. Objective The aim of this study is to report the system-wide accelerated implementation of telemedicine, compare patient satisfaction between telemedicine and in-person visits, and report provider perceptions. Methods This study was conducted at the UC Christus Health Network, a large private academic health network in Santiago, Chile. The satisfaction of patients receiving telemedicine care in March and April 2020 was compared to those receiving in-person care during the same period (concurrent control group) as well as in March and April 2019 (retrospective control group). Patient satisfaction with in-person care was measured using the Net Promoter Score (NPS) survey. Patient satisfaction with telemedicine was assessed with an online survey assessing similar domains. Providers rated their satisfaction and responded to open-ended questions assessing challenges, strategies used to address challenges, the diagnostic process, treatment, and the patient-provider relationship. Results A total of 3962 patients receiving telemedicine, 1187 patients from the concurrent control group, and 1848 patients from the retrospective control group completed the surveys. Satisfaction was very high with both telemedicine and in-person services. Overall, 263 physicians from over 41 specialties responded to the survey. During telemedicine visits, most providers felt their clinical skills were challenged (61.8%). Female providers felt more challenged than male providers (70.7% versus 50.9%, P=.002). Surgeons, obstetricians, and gynecologists felt their clinical skills were challenged the least, compared to providers from nonsurgical specialties (P<.001). Challenges related to the delivery modality, diagnostic process, and patient-provider relationship differed by provider specialty (P=.046, P<.001, and P=.02, respectively). Conclusions Telemedicine implemented in response to the COVID-19 pandemic produced high patient and provider satisfaction. Specialty groups perceived the impact of this new mode of clinical practice differently.

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Section: Discussionmentioning

confidence: 99%

System-Wide Accelerated Implementation of Telemedicine in Response to COVID-19: Mixed Methods Evaluation

García-Huidobro¹,

Rivera²,

Chang³

et al. 2020

J Med Internet Res

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“…Virtual care has the potential to provide access to people who live in more rural areas, who tend to have lower socioeconomic status, are older, and have lower levels of education, but only if the patient can access video and audio equipment, spend the time to use and troubleshoot the equipment, and learn to use programs and hardware they may have never used before. There is a need for engagement and commitment from all stakeholders in the health care system to ensure that virtual care can successfully provide equitable access, closing the gap between rural and urban health care [ 25 ].…”

Section: Role Of Virtual Care In Addressing Barriers To Health Carementioning

confidence: 99%

Patient Care During the COVID-19 Pandemic: Use of Virtual Care

Wong¹,

Bhyat²,

Srivastava³

et al. 2021

J Med Internet Res

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Virtual care, the use of videoconferencing technology to connect with patients, has become critical in providing continuing care for patients during the current COVID-19 pandemic. Virtual care has now been adopted by health care providers across the spectrum, including physicians, residents, nurse practitioners, nurses, and allied health care professionals. Virtual care is novel and nuanced compared to in-person care. Most of the health care providers who are delivering or expected to deliver virtual care have little to no prior experience with it. The nuances of virtual care involve regulatory standards, platforms, technology and troubleshooting, patient selection, etiquette, and workflow, all of which comprise critical points in the provision of health care. It is important to consistently deliver high-quality, equitable, and professional virtual care to inspire patients with the trust they need to continue follow-up of their care in these difficult times. We have been adopting virtual care in our clinical practice for over two years. In partnership with Canada Health Infoway, we have assembled a primer for virtual care that can serve as a guide for any health care provider in Canada and globally, with the goal of providing seamless transitions between in-person and virtual care.

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“…While there is the burgeoning literature which applies geospatial analysis or assesses geographic patterns for health outcomes of interest, in general, geospatial analysis is still underutilized for clinical research. 44,[51][52][53][54] Geospatial analysis findings (MHCs as a geographic risk factor for AEs) may not be captured via conventional quantitative analysis, which typically relies on a priori list of variables.…”

Section: Discussionmentioning

confidence: 99%

Mobile home residence as a risk factor for adverse events among children in a mixed rural–urban community: A case for geospatial analysis

Patel

Wheeler

et al. 2020

J. Clin. Trans. Sci.

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Background: Given the significant health effects, we assessed geospatial patterns of adverse events (AEs), defined as physical or sexual abuse and accidents or poisonings at home, among children in a mixed rural–urban community. Methods: We conducted a population-based cohort study of children (<18 years) living in Olmsted County, Minnesota, to assess geographic patterns of AEs between April 2004 and March 2009 using International Classification of Diseases, Ninth Revision codes. We identified hotspots by calculating the relative difference between observed and expected case densities accounting for population characteristics ( $$Relative\;Difference = {\rm{ }}{{Observed\;Case\;Density - Expected\;Case\;Density} \over {Expected\;Case\;Density}}$$ ; hotspot ≥ 0.33) using kernel density methods. A Bayesian geospatial logistic regression model was used to test for association of subject characteristics (including residential features) with AEs, adjusting for age, sex, and socioeconomic status (SES). Results: Of the 30,227 eligible children (<18 years), 974 (3.2%) experienced at least one AE. Of the nine total hotspots identified, five were mobile home communities (MHCs). Among non-Hispanic White children (85% of total children), those living in MHCs had higher AE prevalence compared to those outside MHCs, independent of SES (mean posterior odds ratio: 1.80; 95% credible interval: 1.22–2.54). MHC residency in minority children was not associated with higher prevalence of AEs. Of addresses requiring manual correction, 85.5% belonged to mobile homes. Conclusions: MHC residence is a significant unrecognized risk factor for AEs among non-Hispanic, White children in a mixed rural–urban community. Given plausible outreach difficulty due to address discrepancies, MHC residents might be a geographically underserved population for clinical care and research.

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Advancing health equity and access using telemedicine: a geospatial assessment

Cited by 122 publications

References 48 publications

System-Wide Accelerated Implementation of Telemedicine in Response to COVID-19: Mixed Methods Evaluation

System-Wide Accelerated Implementation of Telemedicine in Response to COVID-19: Mixed Methods Evaluation

Patient Care During the COVID-19 Pandemic: Use of Virtual Care

Mobile home residence as a risk factor for adverse events among children in a mixed rural–urban community: A case for geospatial analysis

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