Telemedicine for Patient Management in Remote Areas and Underserved Populations

Mohammadzadeh, Niloofar; Rezayi, Sorayya; Saeedi, Soheila

doi:10.1017/dmp.2022.76

Cited by 11 publications

(7 citation statements)

References 33 publications

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“…9,10 While telehealth may increase availability of follow-up appointments and decrease risk of exposure to communicable diseases, it is possible that telehealth visits may provide suboptimal evaluation in certain scenarios and paradoxically increase the rate that patients return to the hospital. [11][12][13][14] As a first step toward understanding the effectiveness of post-ED discharge follow-up by telehealth, we examined the association between in-person and telehealth post-ED discharge follow-up visits with subsequent 30-day ED return (primary outcome) and hospitalization (secondary outcome). We hypothesized that the limitations of telemedicine may create challenges for the care of many patients recently discharged from the ED and that telemedicine would be associated with greater subsequent acute hospital utilization compared with patients who obtain in-person follow-up visits.…”

Section: Introductionmentioning

confidence: 99%

“…Telehealth—the use of synchronous telephone and video technologies and services to provide health care from a distance—underwent rapid adoption since 2020 and now represents 30% of all outpatient care and 34% of all primary care visits . While telehealth may increase availability of follow-up appointments and decrease risk of exposure to communicable diseases, it is possible that telehealth visits may provide suboptimal evaluation in certain scenarios and paradoxically increase the rate that patients return to the hospital …”

Section: Introductionmentioning

confidence: 99%

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Association Between In-Person vs Telehealth Follow-up and Rates of Repeated Hospital Visits Among Patients Seen in the Emergency Department

et al. 2022

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ImportanceFor patients discharged from the emergency department (ED), timely outpatient in-person follow-up is associated with improved mortality, but the effectiveness of telehealth as follow-up modality is unknown.ObjectiveTo evaluate whether the rates of ED return visits and hospitalization differ between patients who obtain in-person vs telehealth encounters for post-ED follow-up care.Design, Setting, and ParticipantsThis retrospective cohort study included adult patients who presented to either of 2 in-system EDs of a single integrated urban academic health system from April 1, 2020, to September 30, 2021; were discharged home; and obtained a follow-up appointment with a primary care physician within 14 days of their index ED visit (15 total days).ExposuresIn-person vs telehealth post–ED discharge follow-up within 14 days.Main Outcomes and MeasuresMultivariable logistic regression was used to estimate the odds of ED return visits (primary outcome) or hospitalization (secondary outcome) within 30 days of an ED visit based on the modality of post–ED discharge follow-up. Models were adjusted for age, sex, primary language, race, ethnicity, Social Vulnerability Index, insurance type, distance to the ED, ambulatory billing codes for the index visit, and the time from ED discharge to follow-up.ResultsOverall, 12 848 patients with 16 987 ED encounters (mean [SD] age, 53 [20] years; 9714 [57%] women; 2009 [12%] Black or African American; 3806 [22%] Hispanic or Latinx; and 9858 [58%] White) were included; 11 818 (70%) obtained in-person follow-up, and 5169 (30%) obtained telehealth follow-up. Overall, 2802 initial ED encounters (17%) led to returns to the ED, and 676 (4%) led to subsequent hospitalization. In adjusted analyses, telehealth vs in-person follow-up visits were associated with increased rates of ED returns (28.3 [95% CI, 11.3-45.3] more ED returns per 1000 encounters) and hospitalizations (10.6 [95% CI, 2.9-18.3] more hospitalizations per 1000 encounters).Conclusions and RelevanceIn this cohort study of patients in an urban integrated health care system, those with telehealth follow-up visits after an ED encounter were more likely to return to the ED and be hospitalized than patients with in-person follow-up. The use of telehealth warrants further evaluation to examine its effectiveness as a modality for continuing care after an initial ED presentation for acute illness.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Association Between In-Person vs Telehealth Follow-up and Rates of Repeated Hospital Visits Among Patients Seen in the Emergency Department

et al. 2022

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“…Given the sparse distribution of specialists in North America, establishing a multi-specialty management team represents one of many challenges facing cancer care providers in rural and remote locations. Screening and early detection have also been traditionally inadequate in underserved areas throughout North America [42][43][44]. The lack of early detection programs has been linked to cancer mortality rates as high as 30% in some remote areas of the United States [45].…”

Section: Teleoncology For Enhancing Cancer Screening and Early Detectionmentioning

confidence: 99%

“…In the absence of teleoncology, such screening is arduous in remote locations. Most of the commonly used screening methods, such as mammography, colonoscopy, Papanicolaou (pap) smear, prostate-specific antigen (PSA), skin biopsy, and other pathology tests, can be accurately interpreted via teleoncology [42,44,[46][47][48]. A recent initiative in Arizona successfully used teleoncology to screen immigrant, Hispanic women, and Native American women in remote locations for cervical and breast cancer [44,49].…”

Section: Teleoncology For Enhancing Cancer Screening and Early Detectionmentioning

confidence: 99%

Teleoncology: Novel Approaches for Improving Cancer Care in North America

Elder,

Alazawi,

Shafaq

et al. 2023

Cureus

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Due to widespread healthcare workforce shortages, many patients living in remote and rural North America currently have reduced access to various medical specialists. These shortages, coupled with the aging North American population, highlight the need to transform contemporary healthcare delivery systems. The exchange of medical information via telecommunication technology, known as telemedicine, offers promising solutions to address the medical needs of an aging population and the increased demand for specialty medical services. This progressive movement has also improved access to quality health care by mitigating the current shortage of trained subspecialists. Minimizing the effects of these shortages is particularly urgent in the care of cancer patients, many of whom require regular follow-up and close monitoring. Cancer patients living in remote areas of North America have reduced access to specialized care and, thus, have unacceptably high mortality and morbidity rates. Teleoncology, or the use of telemedicine to provide oncology services remotely, has the ability to improve access to high-quality care and assist in alleviating the burden of some of the severe adverse events associated with cancer. In this review, the authors describe how recent advances in teleoncology can reduce healthcare disparities and improve future cancer care in North America.

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“…Increased telehealth visits also helped conserve medical supplies, manage the surge in demand for clinical services, and reduce community and nosocomial spread [ 2 ]. Beyond its value in a pandemic, telehealth has also been shown to reduce costs, save time for patients, improve patients’ quality of life, and provide access to care in remote areas [ 3 ]. While telehealth options existed before the pandemic, many health systems reported low rates of utilization [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Accuracy of Telehealth Visits for Acute Care Needs in Family Medicine

Farford,

Bulbarelli,

Ricketts

et al. 2024

Cureus

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IntroductionAs primary care practices transition to a post-pandemic system of healthcare, it is important to recognize the benefits of offering telehealth services. Little research is available on the effectiveness of telehealth visits for managing acute illnesses or conditions in primary care practice. MethodsUsing the reporting functionality in the Epic™ electronic health record (EHR) (Epic Systems Corporation, Verona), a report was generated to identify all telehealth visit encounters that were completed in a family medicine clinic from March 1, 2020, to June 30, 2020. The report identified patients who had an acute complaint and required an in-office visit within 60 days of the telehealth encounter. If the patient required a face-to-face visit, that was not directed by the provider, the chart was reviewed to determine whether the diagnosis changed. The primary outcome was returning for a face-to-face visit within 30 days of the telehealth visit for the same acute need. ResultsThe cohort included 349 telehealth visits for 303 patients. For patients who had more than one telehealth visit, only the first one was included in the analysis. Among the 303 patients, 50 (16.5%) returned for a faceto-face visit within 30 days of the telehealth visit (95% confidence interval: 12.5%-21.2%), and 71 (23.6%) returned for a telehealth visit within 60 days (95% confidence interval: 18.9%-28.8%). Furthermore, 19 of the 50 patients (38%) that returned for a face-to-face visit did not have a change in diagnosis, and, in some instances, the diagnosis made on the telehealth visit was only slightly different from the face-to-face visit. Discussion and conclusionTelehealth, specifically two-way, synchronous, interactive patient-provider communication through audio and video equipment, for acute care needs in a primary care practice helps reduce the need for in-person visits and can address patient complaints without the need for in-person follow-up.

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Telemedicine for Patient Management in Remote Areas and Underserved Populations

Cited by 11 publications

References 33 publications

Association Between In-Person vs Telehealth Follow-up and Rates of Repeated Hospital Visits Among Patients Seen in the Emergency Department

Association Between In-Person vs Telehealth Follow-up and Rates of Repeated Hospital Visits Among Patients Seen in the Emergency Department

Teleoncology: Novel Approaches for Improving Cancer Care in North America

Accuracy of Telehealth Visits for Acute Care Needs in Family Medicine

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