Lessons Learned During COVID-19 That Can Move Telehealth in Primary Care Forward

Knierim, Kyle; Palmer, Christina G.S.; Kramer, Erik Seth; Rodriguez, Rachel S.; VanWyk, Jill; Shmerling, Alison; Smith, Peter C.; Holmstrom, Heather; Bacak, Brian S.; Levey, S; Staton, Elizabeth W.; Holtrop, Jodi Summers

doi:10.3122/jabfm.2021.s1.200419

Cited by 27 publications

(27 citation statements)

References 16 publications

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“…Telehealth is broadly defined as using technology for a remote medical encounter [ 3 ]. Recent research on PC and telehealth services has expanded rapidly both within VA, as well as outside of VA, focusing on a wide variety of topics, such as identifying ways to integrate telehealth in PC [ 8 , 9 ], patient satisfaction with telehealth services [ 10 ], organizational and external factors associated with video use [ 11 ], patient characteristics of telehealth use and disparities in access to video visits [ 6 , 12 , 13 ], among other topics. Like many healthcare settings, access to VA telehealth services, especially VA Video Connect (VVC) [ 6 , 11 ], which is the primary approved platform for patient home-based video visits at the VA [ 14 – 19 ], increased dramatically immediately after onset of COVID-19 [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Examining telehealth use among primary care patients, providers, and clinics during the COVID-19 pandemic

et al. 2022

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Background At the onset of COVID-19, there was a rapid expansion of telehealth (video/telephone) visits to maintain delivery of primary care (PC) services at the Veterans Health Administration (VA). This study examines patient, provider, and site-level characteristics of any virtual and video-based care in PC. Methods Interrupted time series (ITS) design was conducted using VA administrative/clinical, electronic healthcare data, 12-months before and 12-months after COVID-19 onset (set at March 2020) at the VA Greater Los Angeles Healthcare System (GLA), between 2019 and 2021. Patients with at least one visit to a VA PC clinic at GLA (n = 547,730 visits) were included in the analysis. The two main outcomes for this study were 1) any telehealth (versus in-person), as well as 2) video-based care (versus telephone). For the ITS analysis, segmented logistic regression on repeated monthly observations of any telehealth and video-based care was used. Results Percent telehealth and video use increased from 13.9 to 63.1%, and 0.3 to 11.3%, respectively, before to after COVID-19 onset. According to adjusted percentages, GLA community-based clinics (37.7%, versus 29.8% in hospital-based clinics, p < .001), social workers/pharmacists/dietitians (53.7%, versus 34.0% for PC clinicians, p < .001), and minority groups, non-Hispanic African Americans (36.3%) and Hispanics (34.4%, versus 35.3% for Whites, p < .001) were more likely to use telephone than video. Conversely, mental health providers (43.3%) compared to PC clinicians (15.3%), and women (for all age groups, except 75+) compared to men, were more likely to use video than telephone (all p’s < .001). Conclusions Since telehealth care provision is likely to continue after COVID-19, additional research is needed to identify which PC outpatient services are better suited for telephone (e.g., case management) versus video-based care (e.g., integrated mental health visits). Additionally, it is important to understand how all clinics can systematically increase access to both telephone- and video-based PC services, while ensuring equitable care for all patient populations.

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Section: Introductionmentioning

confidence: 99%

Examining telehealth use among primary care patients, providers, and clinics during the COVID-19 pandemic

et al. 2022

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“…They appear to encourage greater physical activity, promote a healthier lifestyle, help manage chronic conditions and, indeed, to be viable alternatives to traditional one-on-one interventions [ 3 , 23 , 24 ]. Nevertheless, despite initial promising research results, the adoption of these technologies has been limited, and even waned after the first wave of excitement [ 25 ]. Additional evidence is required to identify “best practices” for maintaining viable clinician–patient interactions that promote activity and participation, while supporting families in their efforts to manage their children’s health condition and psychological well-being.…”

Section: Introductionmentioning

confidence: 99%

Lessons Learned during a Naturalistic Study of Online Treatment for Pediatric Rehabilitation

Gefen

Steinhart

Beeri

et al. 2021

IJERPH

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The COVID-19 pandemic forced many health care providers to modify their service model by adopting telehealth and tele-rehabilitation with minimal time to plan for its execution. ALYN—Pediatric Rehabilitation Hospital in Jerusalem, Israel, responded with alacrity by providing a broad range of rehabilitation services to young people via online therapy during the first 5 months of the pandemic. The objectives of this naturalistic study were: (1) to monitor usage and user experience of online rehabilitation provided to young people receiving out-patient sessions of physical therapy, occupational therapy, speech and language therapy and psychology and (2) to consider the advantages and disadvantages of retaining this model of online treatment in full or in part post-COVID-19. The online rehabilitation treatment program was provided to 147 young people, aged 3 months to 20 years (mean 8.5 y; SD 5.3), and monitored and evaluated via data from the medical records as well as interviews, questionnaires and focus groups. The results use descriptive and inferential statistics to analyze data on the types and frequencies of therapy provided to 147 young people. Over a five month-period, 2392 therapy sessions were provided, 61 therapists from four disciplines were involved and 56.4% of the young people received two or more types of therapies via online rehabilitation. A repeated measures ANOVA showed significant differences over time per therapy. Feedback and recommendations about the process from therapists, parents and young people were collected during two focus groups of the professional staff (n = 12), parents and young people (parents n = 5, young people n = 3). Tele-rehabilitation services were perceived to be beneficial and effective by the great majority of young people, their parents and the healthcare professionals. The results are discussed within the context of conventional therapy as well as in comparison to reports of other online services for similar populations. We conclude that a hybrid approach in which in-person therapy sessions are coordinated with synchronous, online sessions, will provide a best-case fit for young people with chronic disabilities.

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“…These findings echo those of other national studies showing that significant changes to primary care clinical practice were ubiquitous throughout the United States during this time, 11 , 14 including a rapid shift to the use of telemedicine in the first months of the pandemic. 10 , 15 - 18 …”

Section: Discussionmentioning

confidence: 99%

Early Response of Primary Care Practices to COVID-19 Pandemic

Keppel

Cole

Ramsbottom

et al. 2022

J Prim Care Community Health

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Introduction: The emergence of the COVID-19 pandemic and subsequent public health mitigation strategies resulted in rapid and significant changes to delivery of primary care. The field of primary care faced an unprecedented dual challenge of providing routine care to patients while ensuring patient and staff safety and managing patients with a highly transmissible disease. This study describes how a diverse group of primary care practices addressed these challenges at the start of the COVID-19 pandemic, in Spring 2020. Methods: A cross-sectional electronic survey of representatives from primary care practices in the WWAMI region Practice and Research Network (WPRN). Survey topics included clinical workforce, operations, and use of telemedicine in the first 3 months of the COVID-19 pandemic. Results: To safely manage patients with COVID-19 symptoms all clinics modified operations; 81.3% diverted patients with respiratory symptoms to a telemedicine evaluation, 68.8% diverted these patients to be seen in-person at another location, and 75% made in-clinic changes to maintain safety. The set of operational changes employed by clinics was diverse. To continue to provide routine patient care, all clinics employed telemedicine. Over 80% of clinics had never used telemedicine prior to March 2020. Conclusions: A diverse group of primary care clinics all rapidly implemented a variety of operational adaptations to address patient needs and maintain patient and staff safety at the onset of the COVID- 19 pandemic. Telemedicine, together with other measures, provided critical pathways for maintaining delivery of care.

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Lessons Learned During COVID-19 That Can Move Telehealth in Primary Care Forward

Cited by 27 publications

References 16 publications

Examining telehealth use among primary care patients, providers, and clinics during the COVID-19 pandemic

Examining telehealth use among primary care patients, providers, and clinics during the COVID-19 pandemic

Lessons Learned during a Naturalistic Study of Online Treatment for Pediatric Rehabilitation

Early Response of Primary Care Practices to COVID-19 Pandemic

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