Urgent and non-emergent telehealth care for seniors: Findings from a multi-site impact study

Bernstein, Paul S.; Ko, Kelly J.; Israni, Juhi; Cronin, Alexandria O; Kurliand, Michael M; Shi, Jiaxiao; Chung, Joanie; Borgo, Lina; Reed, Amanda; Kosten, Larissa; Chang, Anna Marie; Sites, Frank D.; Funahashi, Tadashi T.; Agha, Zia

doi:10.1177/1357633x211004321

Cited by 12 publications

(6 citation statements)

References 17 publications

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“…Since 2010, the Veterans Health Administration has incorporated scheduled telephone visits into their patient-centered medical home model to improve care access and efficiency [ 84 , 89 ]. In studies with seniors and in mental health settings, audio-only phone visits were as effective as video in resolving urgent and nonemergent needs [ 90 , 91 ]. And in safety-net populations, telephone visits during the pandemic increased access to care, reduced wait times, and in certain circumstances, offered high quality of care comparable to that of video visits [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Digitally Disconnected: Qualitative Study of Patient Perspectives on the Digital Divide and Potential Solutions

et al. 2021

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Background As telemedicine utilization increased during the COVID-19 pandemic, divergent usage patterns for video and audio-only telephone visits emerged. Older, low-income, minority, and non-English speaking Medicaid patients are at highest risk of experiencing technology access and digital literacy barriers. This raises concern for disparities in health care access and widening of the “digital divide,” the separation of those with technological access and knowledge and those without. While studies demonstrate correlation between racial and socioeconomic demographics and technological access and ability, individual patients’ perspectives of the divide and its impacts remain unclear. Objective We aimed to interview patients to understand their perspectives on (1) the definition, causes, and impact of the digital divide; (2) whose responsibility it is to address this divide, and (3) potential solutions to mitigate the digital divide. Methods Between December 2020 and March 2021, we conducted 54 semistructured telephone interviews with adult patients and parents of pediatric patients who had virtual visits (phone, video, or both) between March and September 2020 at the University of Chicago Medical Center (UCMC) primary care clinics. A grounded theory approach was used to analyze interview data. Results Patients were keenly aware of the digital divide and described impacts beyond health care, including employment, education, community and social contexts, and personal economic stability. Patients described that individuals, government, libraries, schools, health care organizations, and even private businesses all shared the responsibility to address the divide. Proposed solutions to address the divide included conducting community technology needs assessments and improving technology access, literacy training, and resource awareness. Recognizing that some individuals will never cross the divide, patients also emphasized continued support of low-tech communication methods and health care delivery to prevent widening of the digital divide. Furthermore, patients viewed technology access and literacy as drivers of the social determinants of health (SDOH), profoundly influencing how SDOH function to worsen or improve health disparities. Conclusions Patient perspectives provide valuable insight into the digital divide and can inform solutions to mitigate health and resulting societal inequities. Future work is needed to understand the digital needs of disconnected individuals and communities. As clinical care and delivery continue to integrate telehealth, studies are needed to explore whether having a video or audio-only phone visit results in different patient outcomes and utilization. Advocacy efforts to disseminate public and private resources can also expand device and broadband internet access, improve technology literacy, and increase funding to support both high- and low-tech forms of health care delivery for the disconnected.

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Section: Discussionmentioning

confidence: 99%

Digitally Disconnected: Qualitative Study of Patient Perspectives on the Digital Divide and Potential Solutions

et al. 2021

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“…The study also noted that certain conditions could be similarly addressed with either phone or videoconference visits (e.g. UTI) (Bernstein et al, 2021).…”

Section: Introductionmentioning

confidence: 85%

“…A large retrospective cohort from the United States involving 313,516 telehealth visits in adults over 60 years from 2015 to 2019 (Bernstein et al, 2021) found that 84-87% of urgent and nonurgent primary care issues were resolved (Bernstein et al, 2021). For those patients who needed further visits, 95% of these were resolved in less than three visits (either in person or virtual) (Bernstein et al, 2021). The study also noted that certain conditions could be similarly addressed with either phone or videoconference visits (e.g.…”

Section: Introductionmentioning

confidence: 99%

“…There is increasing support for the use of virtual care in older adults, and rapid uptake during the COVID-19 pandemic has provided an understanding of usefulness Liu et al, 2021). A large retrospective cohort from the United States involving 313,516 telehealth visits in adults over 60 years from 2015 to 2019 (Bernstein et al, 2021) found that 84-87% of urgent and nonurgent primary care issues were resolved (Bernstein et al, 2021). For those patients who needed further visits, 95% of these were resolved in less than three visits (either in person or virtual) (Bernstein et al, 2021).…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of virtual interventions for reducing symptoms of depression in community-dwelling older adults: a systematic review

Goodarzi

Holroyd‐Leduc

Seitz

et al. 2022

Int. Psychogeriatr.

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Background: Older adults experience symptoms of depression, leading to suffering and increased morbidity and mortality. Although we have effective depression therapies, physical distancing and other public health measures have severely limited access to in-person interventions. Objective: To describe the efficacy of virtual interventions for reducing symptoms of depression in community-dwelling older adults. Design: Systematic review. Setting: We searched MEDLINE, EMBASE, Cochrane Libraries, PsycINFO, and gray literature from inception to July 5, 2021. Participants and interventions: We included randomized trials (RCTs) comparing the efficacy of virtual interventions to any other virtual intervention or usual care in community-dwelling adults ≥60 years old experiencing symptoms of depression or depression as an outcome. Measurements: The primary outcome was change in symptoms of depression measured by any depression scale. Results: We screened 12,290 abstracts and 830 full text papers. We included 15 RCTs (3100 participants). Five RCTs examined persons with depression symptoms at baseline and ten examined depression as an outcome only. Included studies demonstrated feasibility of interventions such as internet or telephone cognitive behavioral therapy with some papers showing statistically significant improvement in depressive symptoms. Conclusions: There is a paucity of studies examining virtual interventions in older adults with depression. Given difficulty in accessing in-person therapies in a pandemic and poor access for people living in rural and remote regions, there is an urgent need to explore efficacy, effectiveness, and implementation of virtual therapies.

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“…Throughout the works reviewed, community support of telehealth appeared to be a vital component holding a key to client utilization with researchers finding that telehealth services supported by a client's personal healthcare provider, schools of nursing and medicine, or community-based centers were more likely to be well-received (Bernstein et al, 2021;Office et al, 2020;Resnick et al, 2012). According to Pierce et al (2021) increased telehealth use was significantly correlated with training (p=0.002) and organizational encouragement (p=0.003).…”

mentioning

confidence: 99%

Telehealth Acceptance among Appalachian Respondents During COVID 19: A Secondary Data Analysis

Hood-Wells¹,

Weierbach²,

Wahlquist³

et al. 2022

OJRNHC

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Purpose:The purpose of this study is to examine the relationship between telehealth use, telehealth satisfaction, and chronic medical conditions among residents living in Appalachian and non-Appalachian communities. Sample:A COVID-19 public health survey was distributed via social media and healthcare clinics in the tri-state region of central Appalachia. Survey responses were limited to adults aged ≥18 years who consented to participate in the survey that self-identified as an individual with one or more chronic medical conditions (n=195).Method: Simple descriptive statistics including frequencies, percentages, means, and standard deviations (SDs) were calculated for variables of interest both overall and by subgroups of interest.Chi-squared tests were used to compare categorical outcomes between groups of interest, while two-sample t-tests were used for continuous outcomes. Significance for all tests was determined using an α level of 0.05. Findings:There is no statistically significant relationship between respondents with regard to using telehealth services, satisfaction rates related to telehealth use, or reasons for electing not to use telehealth services during the COVID-19 pandemic. However, there was a trending statistical relationship between county status and the use of telehealth services in Appalachia with those counties doing economically better being more likely to use telehealth services as compared to those fairing less well (p=0.053). Findings also suggest that people living in urban areas of Appalachia were more likely to be satisfied using telehealth services than those living in non-urban areas of Appalachia (p=0.01). Conclusions:Research is still limited as to how the expansion of broadband capabilities during the COVID-19 pandemic has benefited those residing in Appalachia in terms of managing chronic

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Urgent and non-emergent telehealth care for seniors: Findings from a multi-site impact study

Cited by 12 publications

References 17 publications

Digitally Disconnected: Qualitative Study of Patient Perspectives on the Digital Divide and Potential Solutions

Digitally Disconnected: Qualitative Study of Patient Perspectives on the Digital Divide and Potential Solutions

Efficacy of virtual interventions for reducing symptoms of depression in community-dwelling older adults: a systematic review

Telehealth Acceptance among Appalachian Respondents During COVID 19: A Secondary Data Analysis

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