Telehealth in the COVID-19 Era: A Balancing Act to Avoid Harm

Reeves, James J.; Ayers, John W.; Longhurst, Chris

doi:10.2196/24785

Cited by 70 publications

(68 citation statements)

References 28 publications

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“…Aside from the initial plans to prevent COVID-19 infection risks, the consequences of lifting the ban on telephone re-examination, in terms of actual efficacy and safety, has hardly been validated in Japanese clinical settings. Although currently, there are no established guidelines, careful evaluation will be needed beforehand to determine the diseases or cases for which the use of telephone re-examination may be especially inappropriate (12,34). For example, patients with epilepsy and poor sleep quality were found to have an increased risk of worsening seizures during COVID-19 in Italy (34).…”

Section: Discussionmentioning

confidence: 99%

“…In accordance with the perceived risk of visiting outpatient clinics (8), some patients with neurological disease may have cancelled their routine visits, and others might have adapted by increasing the number of prescription days or by receiving ambulatory care using telephone (9,10), thereby attempting to decrease the frequency of direct visits to the outpatient clinic (11). However, because in-person visit is deemed essential especially for the ambulatory care of patients with neurological diseases (12), there may remain some medium-or long-term safety concerns about these measures against COVID-19.…”

mentioning

confidence: 99%

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The impact of COVID-19 pandemic on the utilization of ambulatory care for patients with chronic neurological diseases in Japan: Evaluation of an administrative claims database

Sato

Mano

Niimi

et al. 2021

BST

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The global coronavirus disease (COVID-19) pandemic, since early 2020, has severely affected not only the emergency medical system in Japan (1), but also patient care at the outpatient clinics. To reduce the risk of COVID-19 infection, people were requested to refrain from unnecessary and nonurgent outings or from visiting crowded places, with a call to "avoid the three Cs" (closed spaces, crowded places, and close-contact settings) (2) based on the Act on Special Measures for Pandemic Influenza and New Infectious Diseases Preparedness and Response (https://elaws.e-gov.go.jp/document?lawid=4 24AC0000000031). People also refrained from visiting outpatient clinics (3), leading to a significant decrease in the number of ambulatory visits to internal medicine outpatient clinics in Japan by more than 10% in April-May 2020 compared to April-May 2019 (4). In addition, the ban on subsequent visits by telephone (or telephone re-examination) at outpatient clinics as an alternative to ambulatory care for chronic diseases was removed by the Ministry of Health, Labor and Welfare (MHLW) since March 2020 as an exceptional measure against the COVID-19 pandemic (5): in terms of reimbursement, it became newly available to claim a "subsequent visit fee" along with the "prescription fee", even in case of telephone visits.What is concerned in these measures against COVID-19 pandemic is that they are not always feasible for some patients with chronic neurological diseases (e.g., dementia, epilepsy, or Parkinson's disease), who are one of those considered as vulnerable to COVID-19 infection due to their old age or comorbid status (6). Since patients with chronic neurological diseases need

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

The impact of COVID-19 pandemic on the utilization of ambulatory care for patients with chronic neurological diseases in Japan: Evaluation of an administrative claims database

Sato

Mano

Niimi

et al. 2021

BST

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“…Further, the virtual nature of telemedicine has the potential to hinder patient-provider communication; for example, in one study where patients expressed concerns about errors in their care due to the lack of physical exam, they reported feeling less involved during the visit and had difficulty finding opportunities to speak [23]. Other studies have summarized further communication drawbacks, including lack of physical touch, difficulty building rapport, and decreased ability to recognize subtle nonverbal cues and expressions [2,24].…”

Section: What We Know About Patient-centered Care and Telemedicinementioning

confidence: 99%

“…Supervising clinicians should teach trainees how each of these tasks looks different in the virtual setting and coach them on how to troubleshoot technological and communication issues before they arise (Figure 1) [3,4,6]. Additionally, preceptors should pursue opportunities to teach learners how to assess which patients are appropriate for video or phone visits and which situations may be more suited for an in-person visit [6,24]. Supervising attendings should focus on virtual visit communication skills, efficient utilization of the visit platform, setting expectations for the visit with patients, the importance of body language and speech [3,4,6], and strategies to engage patients by using video tools such as "screen share" (Figure 1).…”

Section: Teaching Patient-centered Telemedicinementioning

confidence: 99%

Teaching Telemedicine: The Next Frontier for Medical Educators

Alkureishi¹,

Lenti²,

Choo³

et al. 2021

JMIR Med Educ

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The COVID-19 pandemic has pushed telemedicine to the forefront of health care delivery, and for many clinicians, virtual visits are the new normal. Although telemedicine has allowed clinicians to safely care for patients from a distance during the current pandemic, its rapid adoption has outpaced clinician training and development of best practices. Additionally, telemedicine has pulled trainees into a new virtual education environment that finds them oftentimes physically separated from their preceptors. Medical educators are challenged with figuring out how to integrate learners into virtual workflows while teaching and providing patient-centered virtual care. In this viewpoint, we review principles of patient-centered care in the in-person setting, explore the concept of patient-centered virtual care, and advocate for the development and implementation of patient-centered telemedicine competencies. We also recommend strategies for teaching patient-centered virtual care, integrating trainees into virtual workflows, and developing telemedicine curricula for graduate medical education trainees by using our TELEMEDS framework as a model.

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“…The copyright holder for this preprint this version posted May 10, 2021. ; https://doi.org/10.1101/2021.05.10.21256951 doi: medRxiv preprint some medium-or long-term safety concerns about their disease control, because in-person re-examination is deemed essential, especially for the ambulatory care of patients with neurological diseases [10].…”

Section: Introductionmentioning

confidence: 99%

The impact of COVID-19 pandemic on the provision of ambulatory care for patients with chronic neurological diseases in Japan: evaluation of an administrative claims database

Sato

Mano

Niimi

et al. 2021

Preprint

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Background: The COVID-19 pandemic has affected not only the emergency medical system, but also patients' regular ambulatory care. The number of patients visiting outpatient internal medicine clinics decreased during March-April 2020 compared to 2019. Moreover, the ban on telephone re-examination for outpatient clinics in lieu of ambulatory care for chronic diseases has been lifted since March 2020. In this context, we investigate the impact of the COVID-19 pandemic on ambulatory care at Japanese outpatient clinics for patients with chronic neurological diseases during the first half of 2020. Methods: We collected data from the administrative claims database by DeSC Healthcare. Serial changes in the frequency of subsequent outpatient visits to clinics or hospitals (excluding large hospitals with beds >200) for chronic ambulatory care of epilepsy, migraine, Parkinson's disease (PD), and Alzheimer's disease were measured. We also evaluated the utilization rate of telephone re-examination at outpatient clinics. Results: Since April 2020, the monthly count of outpatient clinic visits for epilepsy or PD decreased slightly but significantly. The use of telephone re-examination was facility-dependent, and it was used in less than 5% of all outpatient clinic visits for the examined neurological diseases in May 2020. The utilization rate of telephone re-examination was not associated with age or the neurological diseases of interest. Conclusion: The impact of the COVID-19 pandemic on ambulatory care for several chronic neurological diseases may have been relatively limited, in terms of the frequency or type of outpatient visit, during the first half of 2020 in Japan.

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Telehealth in the COVID-19 Era: A Balancing Act to Avoid Harm

Cited by 70 publications

References 28 publications

The impact of COVID-19 pandemic on the utilization of ambulatory care for patients with chronic neurological diseases in Japan: Evaluation of an administrative claims database

The impact of COVID-19 pandemic on the utilization of ambulatory care for patients with chronic neurological diseases in Japan: Evaluation of an administrative claims database

Teaching Telemedicine: The Next Frontier for Medical Educators

The impact of COVID-19 pandemic on the provision of ambulatory care for patients with chronic neurological diseases in Japan: evaluation of an administrative claims database

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