Background: The aim of this study was to analyze patient satisfaction with telehealth in a rural county on the United States-Mexico border after rapid expansion of telehealth services during the COVID-19 pandemic. Materials and Methods: Chiricahua Community Health Centers, Inc., a federally qualified health center in southeastern Arizona, conducted phone surveys with 562 patients to measure various outcomes related to patient satisfaction and experience with telehealth between June and August 2020. Data from patient surveys were analyzed within the following age categories: <18 years (37%), 18-34 years (19%), 35-54 years (15%), and 55+ years (29%). Results and Discussion: Patients were overall satisfied with telehealth (87%) and believed the quality of care was just as good as or better than in-person appointments (88%). Many would be willing to try telehealth in the future (54%). Distance/ convenience (odds ratio [OR] = 5.01, 95% confidence interval [CI] 2.80-8.97), ease of scheduling (OR = 3.82, 95% CI 1.30-11.21), and protection from potential exposure to coronavirus (OR = 3.01, 95% CI 1.57-5.75) were all strongly predictive of overall satisfaction scores. Adults within the 35-54 (OR = 0.29, 95% CI 0.10-0.81) and 55+ (OR = 0.37, 95% CI 0.14-0.95) age groups were overall less satisfied with telehealth compared with younger adults 18-34 years. Underlying health conditions and primary language were not correlated with satisfaction in using telehealth. Conclusions: Telehealth may be an effective tool for overcoming barriers and providing rural patients with access to health care without compromising patient satisfaction.
Objective In 2014, the US experienced an outbreak of enterovirus D68 (EV-D68) associated with severe respiratory illness. The clinical characteristics associated with severe illness from EV-D68 during this outbreak compared with the 2009 H1N1 influenza virus outbreak are unknown. Design and Setting In this retrospective cohort study, we characterized the clinical features of children with EV-D68 admitted to the pediatric ICU between August 1-November 1, 2014 and compared them with critically-ill children infected with H1N1 influenza during the pandemic admitted between May 1, 2009-January 31, 2010. Patients pediatric ICU patients Interventions none Measurements and Main Results Ninety-seven severely-ill children with EV-D68 infections were compared with 68 children infected with H1N1 influenza during the 2009 pandemic. Children with EV-D68 were more likely to have asthma (62% vs 23%, P< 0.001) and present with reactive airway disease exacerbations, with greater receipt of albuterol (94% vs 49%) and steroids (89% vs 40%, P< 0.0001 for both). While more children with EV-D68 were admitted to the ICU compared with H1N1 influenza, they had a shorter hospital length of stay (4 vs 7 days, P< 0.0001), with lower intubation rates (7% vs 44%), vasopressor use (3% vs 32%), ARDS (3% vs 24%), shock (0% vs 16%) and death (0% vs 12 %, P< 0.05 for all). Compared with children with other enteroviruses and rhinoviruses, children with EV-D68 were more likely to have a history of asthma (64% vs 45%) or multiple prior wheezing episodes (54% vs 34%, P < 0.01 for both). Conclusions Critically-ill children with EV-D68 were more likely to present with reactive airway disease exacerbations, whereas children with H1N1 influenza were more likely to present with pneumonia. Compared to the pandemic H1N1 influenza outbreak, the EV-D68 outbreak resulted in more children requiring admission to the ICU, but was associated with less severe outcomes.
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