Acceptability, Feasibility, and Quality of Telehealth for Adolescent Health Care Delivery During the COVID-19 Pandemic: Cross-sectional Study of Patient and Family Experiences

Abstract

Background Data regarding the acceptability, feasibility, and quality of telehealth among adolescents and young adults (AYA) and their parents and caregivers (caregivers) are lacking. Objective The aim of this study was to assess the noninferiority of telehealth versus in-person visits by comparing acceptability with respect to efficiency, effectiveness, equity, patient-centeredness, and confidentiality. Methods Cross-sectional web-based surveys were sent to caregivers and AYA following video visits within an Adolescent Medicine subspecialty clinic in May-July 2020. Proportions of AYA and caregivers who rated telehealth as noninferior were compared using chi-squared tests. Feasibility was assessed via items measuring technical difficulties. Deductive thematic analysis using the Institute of Medicine dimensions of health care quality was used to code open-ended question responses. Results Survey response rates were 20.5% (55/268) for AYA and 21.8% (123/563) for caregivers. The majority of the respondents were White cisgender females. Most AYA and caregivers rated telehealth as noninferior to in-person visits with respect to confidentiality, communication, medication management, and mental health care. A higher proportion of AYA compared to caregivers found telehealth inferior with respect to confidentiality (11/51, 22% vs 3/118, 2.5%, P<.001). One-quarter (14/55) of the AYA patients and 31.7% (39/123) of the caregivers reported technical difficulties. The dominant themes in the qualitative data included advantages of telehealth for efficiency and equity of health care delivery. However, respondents’ concerns included reduced safety and effectiveness of care, particularly for patients with eating disorders, owing to lack of hands-on examinations, collection of vital signs, and laboratory testing. Conclusions Telehealth was highly acceptable among AYA and caregivers. Future optimization should include improving privacy, ameliorating technical difficulties, and standardizing at-home methods of obtaining patient data to assure patient safety.

The Impact of SARS-CoV-2 Infection on Youth Mental Health: A Narrative Review

“…Overall, the literature suggests that patients were disposed to undertake virtual therapy and recounted largely positive experiences with their eating disorder treatment. Authors found no differences in telehealth visit completion rates among patients [169,172] and some studies further suggested unexpected advantages of telehealth such as a greater level of familial involvement in treatment [159,202]. However, despite the advantages listed above, many patients reported preferring the face-to-face over the online type of appointment [159,169,170].…”

“…For both parameters, the highest percentages were recorded in states with high rates of coronavirus positivity and high rates of unmet need. Also, a cross-sectional web-based survey conducted specifically among adolescents and young adults by Wood et al [172] revealed that telehealth was highly acceptable among them and caregivers. A total of 55 patients and 123 caregivers rated telehealth as noninferior to in-person visits with respect to privacy, communication, managing medication questions, discussing test results, mood, and mental health.…”

Financial burdens during the COVID-19 pandemic are related to disrupted healthcare utilization among survivors of adolescent and young adult cancers

“…The COVID-19 pandemic has taken the lives of over 1,000,000 Americans and strained the capacity of healthcare professionals and systems to care for complex patients [ 1 – 3 ]. Healthcare systems have reduced patient loads to limit in-person contact and preserve resources for COVID-19 care, but these changes have limited capacity for cancer care [ 4 , 5 ]. Shifting to telehealth has been challenging for cancer patients whose care may require laboratory tests or hands-on examination [ 4 , 5 ].…”

“…Healthcare systems have reduced patient loads to limit in-person contact and preserve resources for COVID-19 care, but these changes have limited capacity for cancer care [ 4 , 5 ]. Shifting to telehealth has been challenging for cancer patients whose care may require laboratory tests or hands-on examination [ 4 , 5 ]. While some patients are hesitant to start or continue cancer care during the pandemic, expedient cancer care is still a priority.…”

Evaluation of the rapid implementation of telehealth during the COVID-19 pandemic: a qualitative study among adolescents and their parents

“…Given the paucity and heterogeneity of research on this topic, the rapid and widespread COVID-19-induced implementation of telehealth in European youth mental health services provided a unique opportunity to examine the perspectives of young people and their parents on remote mental health care delivery. Many articles during this period have focused on the experience of health professionals [26,27] and family caregivers [28], but very few on the crosssectional perspectives of adolescents and their parents [29]. The perspectives of both groups are critical for assessing multiple aspects of telemedicine services, including therapeutic alliance quality, communication quality, impact on family routines, and overall satisfaction and acceptability.…”