Virtual Care, Telemedicine Visits, and Real Connection in the Era of COVID-19

Zulman, Donna M.; Verghese, Abraham

doi:10.1001/jama.2020.27304

Cited by 100 publications

(78 citation statements)

References 9 publications

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“…Lastly, the absence of physical presence and contact could also be an issue when implementing TMS in older people’s care, both from a clinical and psychological point of view; however, several humanistic practices have been proposed to help healthcare workers to establish meaningful relationships with patients and caregivers during TMS visits [ 14 ].…”

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confidence: 99%

Telemedicine-assisted care of an older patient with COVID-19 and dementia: bridging the gap between hospital and home

et al. 2021

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Hospital at Home (HaH) has been proposed as a solution to relieve pressure on hospital beds during the COVID-19 pandemic; however, caregivers' feelings of inadequacy and concerns on the need for tighter clinical monitoring might lead to unnecessary and potentially harmful hospital admissions in frail older patients with mild or atypical COVID-19. Here we report the case of a 91-year old woman with severe dementia and atypical COVID-19 that could be successfully managed by our HaH thanks to her highly motivated caregivers and the support of a telemedicine solution (TMS) to provide caregiver training and support as well as supplementary telemonitoring. Despite some well-known issues on TMS use, the hybrid inperson and tele-visit approach of TMS-assisted HaH could help to create a "secure" environment, empowering caregivers to manage frail older adults with COVID-19 at home, avoiding unnecessary admissions to closed wards and their negative physical, functional and psychological outcomes.

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confidence: 99%

Telemedicine-assisted care of an older patient with COVID-19 and dementia: bridging the gap between hospital and home

et al. 2021

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“…While there are no other published reports specifically on virtual care transition management practices, Eberly et al [ 25 ] reported a more balanced distribution of video (45%) and telephone (55%) primary and specialty care visits from a large academic health system from March to May 2020. We expect that video visits will increase over time with greater provider comfort and increased patient access to technology [ 26 ] and also due to telehealth reimbursement for Medicare Advantage plans which took effect in January 1, 2020 but the long-term future of telehealth reimbursement in fee-for-service Medicare remains to be seen after the end of the public health emergency [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Association between post-hospital clinic and telephone follow-up provider visits with 30-day readmission risk in an integrated health system

Nguyen

Baecker

et al. 2021

BMC Health Serv Res

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Background Follow-up visits with clinic providers after hospital discharge may not be feasible for some patients due to functional limitations, transportation challenges, need for physical distancing, or fear of exposure especially during the current COVID-19 pandemic. Methods The aim of the study was to determine the effects of post-hospital clinic (POSH) and telephone (TPOSH) follow-up provider visits versus no visit on 30-day readmission. We used a retrospective cohort design based on data from 1/1/2017 to 12/31/2019 on adult patients (n = 213,513) discharged home from 15 Kaiser Permanente Southern California hospitals. Completion of POSH or TPOSH provider visits within 7 days of discharge was the exposure and all-cause 30-day inpatient and observation stay readmission was the primary outcome. We used matching weights to balance the groups and Fine-Gray subdistribution hazard model to assess for readmission risk. Results Unweighted all-cause 30-day readmission rate was highest for patients who completed a TPOSH (17.3%) followed by no visit (14.2%), non-POSH (evaluation and management visits that were not focused on the hospitalization: 13.6%) and POSH (12.6%) visits. The matching weighted models showed that the effects of POSH and TPOSH visits varied across patient subgroups. For high risk (LACE 11+) medicine patients, both POSH (HR: 0.77, 95% CI: 0.71, 0.85, P < .001) and TPOSH (HR: 0.91, 95% CI: 0.83, 0.99, P = .03) were associated with 23 and 9% lower risk of 30-day readmission, respectively, compared to no visit. For medium to low risk medicine patients (LACE< 11) and all surgical patients regardless of LACE score or age, there were no significant associations for either visit type with risk of 30-day readmission. Conclusions Post-hospital telephone follow-up provider visits had only modest effects on 30-day readmission in high-risk medicine patients compared to clinic visits. It remains to be determined if greater use and comfort with virtual visits by providers and patients as a result of the pandemic might improve the effectiveness of these encounters.

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“…Because medical presentations can vary in acuity and thus warrant different management approaches, physicians may need a real-time modality to assess the patient better, view the site of pathology, discuss treatment options, address the patient's concerns, and promote compliance with the treatment regimen. Video consultations can proximate real-life visits to a great extent as both the physician and patient can interact with each other simultaneously; this negates the psychological distance by allowing facial expressions and body language to be observed and interpreted, thus promoting empathic communication and the generation of a physician-patient rapport [45]. Therefore, a video consultation may be preferable when consulting a new patient for the first time as physicians would feel more confident in making diagnostic and treatment decisions.…”

Section: Principal Findingsmentioning

confidence: 99%

Physicians’ Attitudes Toward Telemedicine Consultations During the COVID-19 Pandemic: Cross-sectional Study

Alhajri¹,

Simsekler²,

Alfalasi³

et al. 2021

JMIR Med Inform

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Background To mitigate the effect of the COVID-19 pandemic, health care systems worldwide have implemented telemedicine technologies to respond to the growing need for health care services during these unprecedented times. In the United Arab Emirates, video and audio consultations have been implemented to deliver health services during the pandemic. Objective This study aimed to evaluate whether differences exist in physicians’ attitudes and perceptions of video and audio consultations when delivering telemedicine services during the COVID-19 pandemic. Methods This survey was conducted on a cohort of 880 physicians from outpatient facilities in Abu Dhabi, which delivered telemedicine services during the COVID-19 pandemic between November and December 2020. In total, 623 physicians responded (response rate=70.8%). The survey included a 5-point Likert scale to measure physician’s attitudes and perceptions of video and audio consultations with reference to the quality of the clinical consultation and the professional productivity. Descriptive statistics were used to describe physicians’ sociodemographic characteristics (age, sex, designation, clinical specialty, duration of practice, and previous experience with telemedicine) and telemedicine modality (video vs audio consultations). Regression models were used to assess the association between telemedicine modality and physicians’ characteristics with the perceived outcomes of the web-based consultation. Results Compared to audio consultations, video consultations were significantly associated with physicians’ confidence toward managing acute consultations (odds ratio [OR] 1.62, 95% CI 1.2-2.21; P=.002) and an increased ability to provide patient education during the web-based consultation (OR 2.21, 95% CI 1.04-4.33; P=.04). There was no significant difference in physicians’ confidence toward managing long-term and follow-up consultations through video or audio consultations (OR 1.35, 95% CI 0.88-2.08; P=.17). Video consultations were less likely to be associated with a reduced overall consultation time (OR 0.69, 95% CI 0.51-0.93; P=.02) and reduced time for patient note-taking compared to face-to-face visits (OR 0.48, 95% CI 0.36-0.65; P<.001). Previous experience with telemedicine was significantly associated with a lower perceived risk of misdiagnosis (OR 0.46, 95% CI 0.3-0.71; P<.001) and an enhanced physician-patient rapport (OR 2.49, 95% CI 1.26-4.9; P=.008). Conclusions These results indicate that video consultations should be adopted frequently in the new remote clinical consultations. Previous experience with telemedicine was associated with a 2-fold confidence in treating acute conditions, less than a half of the perceived risk of misdiagnosis, and an increased ability to provide patients with health education and enhance the physician-patient rapport. Additionally, these results show that audio consultations are equivalent to video consultations in providing remote follow-up care to patients with chronic conditions. These findings may be beneficial to policymakers of e-health programs in low- and middle-income countries, where audio consultations may significantly increase access to geographically remote health services.

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Virtual Care, Telemedicine Visits, and Real Connection in the Era of COVID-19

Cited by 100 publications

References 9 publications

Telemedicine-assisted care of an older patient with COVID-19 and dementia: bridging the gap between hospital and home

Telemedicine-assisted care of an older patient with COVID-19 and dementia: bridging the gap between hospital and home

Association between post-hospital clinic and telephone follow-up provider visits with 30-day readmission risk in an integrated health system

Physicians’ Attitudes Toward Telemedicine Consultations During the COVID-19 Pandemic: Cross-sectional Study

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