Telemedicine, COVID-19, and disparities: Policy implications

Ortega, Gezzer; Rodriguez, Jorge A.; Maurer, Lydia R.; Witt, Emily E.; Perez, Numa P.; Reich, Amanda J.; Bates, David W.

doi:10.1016/j.hlpt.2020.08.001

Cited by 200 publications

(186 citation statements)

References 7 publications

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“…Immediate research interviews with families were not pursued because of the foreshadowed complex grief of those losing loved ones during the pandemic ( 20 , 37 ), particularly if their final connection was mediated by a screen. Although our findings resonate with disparities in technologic access and aptitude, we did not explore sociocultural, cognitive, or linguistic communication barriers; privacy concerns; or “webside manner” ( 28 , 38 ).…”

Section: Discussionmentioning

confidence: 50%

Clinician Perspectives on Caring for Dying Patients During the Pandemic

et al. 2021

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Section: Discussionmentioning

confidence: 50%

Clinician Perspectives on Caring for Dying Patients During the Pandemic

et al. 2021

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“…20,21 Concerns have been raised about virtual visits, including privacy, continuity of care and equity of implementation. 21,22 An Ontario pilot study of virtual care showed that, when provided with a choice of audio, video or text messaging on an integrated platform, more than 90% of visits occurred using asynchronous, secure text messaging followed by audio, yet there are no billing codes for text messaging. 28 Despite extensive use of virtual care in the COVID-19 pandemic, [23][24][25][26][27] the appropriate role of virtual care remains to be determined.…”

Section: Discussionmentioning

confidence: 99%

Shifts in office and virtual primary care during the early COVID-19 pandemic in Ontario, Canada

Glazier

Green

et al. 2021

CMAJ

310

342

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BACKGROUND: Globally, primary care changed dramatically as a result of the coronavirus disease 2019 (COVID-19) pandemic. We aimed to understand the degree to which office and virtual primary care changed, and for which patients and physicians, during the in itial months of the pandemic in Ontario, Canada. METHODS: This population-based study compared comprehensive, linked primary care physician billing data from Jan. 1 to July 28, 2020, with the same period in 2019. We identified Ontario residents with at least 1 office or virtual (telephone or video) visit during the study period. We compared trends in total physician visits, office visits and virtual visits before COVID-19 with trends after pandemic-related public health measures changed the delivery of care, according to various patient and physician characteristics. We used interrupted time series analysis to compare trends in the early and later halves of the COVID-19 period. RESULTS: Compared with 2019, total primary care visits between March and July 2020 decreased by 28.0%, from 7.66 to 5.51 per 1000 people/day. The smallest declines were among patients with the highest expected health care use (8.3%), those who could not be attributed to a primary care physician (10.2%), and older adults (19.1%). In contrast, total visits in rural areas increased by 6.4%. Office visits declined by 79.1% and virtual care increased 56-fold, comprising 71.1% of primary care physician visits. The lowest uptake of virtual care was among children (57.6%), rural residents (60.6%) and physicians with panels of ≥ 2500 patients (66.0%). INTERPRETATION: Primary care in Ontario saw large shifts from office to virtual care over the first 4 months of the COVID-19 pandemic. Total visits declined least among those with higher health care needs. The determinants and consequences of these major shifts in care require further study.

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“…Also, communication with limited education or low‐literacy patients is not suitable. This limitation can reflect even more the disparities already evidenced by the COVID‐19 pandemic 7 . Besides, elderly patients could have difficulty in dealing with technology 8 .…”

Section: Discussionmentioning

confidence: 99%

The use of telemedicine to maintain breast cancer follow‐up and surveillance during the COVID‐19 pandemic

Sonagli

Neto

Leite

et al. 2020

Journal of Surgical Oncology

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As a result from restricted economic activities and social distancing due to the coronavirus disease‐2019 (COVID‐19) pandemic, we observed a 49.4% decrease in outpatient appointments at our Institution. to minimize this impact on screening and oncological follow‐up of breast cancer patients, telemedicine appointments were established. The authors demonstrate how a cancer center in the largest city in Brazil has managed outpatient appointments during the COVID‐19 pandemic. This is a retrospective study of patients who had their appointments through telemedicine at the AC Camargo Cancer Center between June 2020 and October 2020, during the COVID‐19 pandemic. Of the 77 patients who had telemedicine appointments, 36 (46.8%) accounted for breast cancer follow‐up, 20 (26%) for breast cancer screening, 10 (13%) for benign breast disease evaluation, 7 (9%) for a second opinion, and 4 (5.2%) for general orientations. Routine surveillance/follow‐up exams were requested for 45 (58.4%) patients and breast image exams and a request to return for a personal appointment for 30 (39%) patients. Two (2.6%) patients were requested to schedule a personal appointment immediately for a physical exam. In conclusion, telemedicine may be a feasible alternative to reduce personal outpatient appointments for cancer follow‐up and breast cancer screening during the COVID‐19 pandemic.

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Telemedicine, COVID-19, and disparities: Policy implications

Cited by 200 publications

References 7 publications

Clinician Perspectives on Caring for Dying Patients During the Pandemic

Clinician Perspectives on Caring for Dying Patients During the Pandemic

Shifts in office and virtual primary care during the early COVID-19 pandemic in Ontario, Canada

The use of telemedicine to maintain breast cancer follow‐up and surveillance during the COVID‐19 pandemic

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