Telehealth, Rural America, and the Digital Divide

Mishori, Ranit; Antono, Brian

doi:10.1097/jac.0000000000000348

Cited by 35 publications

(29 citation statements)

References 5 publications

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“…Our sample predominantly consisted of African American patients, which reflects the racial makeup of the clinic population more generally and the disproportionate burden of HIV found among this group. Contributing to this limitation, our sample size was relatively small, and we were unable to tease out the differences in patient perspectives by specific characteristics, such as age, race, and place of residence (urban vs rural), despite known disparities in technology use across such factors [ 47 - 49 ]. This limitation also highlights the need to recognize that preferences for communication differ among individuals, and allowing choice is important.…”

Section: Discussionmentioning

confidence: 99%

Patient-Provider Text Messaging and Video Calling Among Case-Managed Patients Living With HIV: Formative Acceptability and Feasibility Study

Fonner¹,

Kennedy²,

Desai³

et al. 2021

JMIR Form Res

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Background Patient-provider communication is critical for engaging and retaining people living with HIV in care, especially among medically case-managed patients in need of service coordination and adherence support. Expanding patient-provider communication channels to include mobile health modalities, such as text messaging and video calling, has the potential to facilitate communication and ultimately improve clinical outcomes. However, the implementation of these communication modalities in clinical settings has not been well characterized. Objective The purpose of this study is to understand patient and provider perspectives on the acceptability of and preferences for using text messaging and video calling as a means of communication; perceived factors relevant to adoption, appropriateness, and feasibility; and organizational perspectives on implementation within an HIV clinic in South Carolina. Methods We conducted 26 semistructured in-depth interviews among patients receiving case management services (n=12) and clinic providers (n=14) using interview guides and content analysis informed by the Proctor taxonomy of implementation outcomes and the Consolidated Framework for Implementation Research. Participants were purposefully sampled to obtain maximum variation in terms of age and gender for patients and clinic roles for providers. The data were analyzed using quantitative and qualitative content analyses. Results Most patients (11/12, 92%) and providers (12/14, 86%) agreed that they should have the capacity to text message and/or video call each other. Although consensus was not reached, most preferred using a secure messaging app rather than standard text messaging because of the enhanced security features. Perceived benefits to adoption included the added convenience of text messaging, and potential barriers included the cost and access of smartphone-based technology for patients. From an organizational perspective, some providers were concerned that offering text messaging could lead to unreasonable expectations of instant access and increased workload. Conclusions Patients and providers perceived text messaging and video calling as acceptable, appropriate, and feasible and felt that these expanded modes of communication could help meet patients’ needs while being safe and not excessively burdensome. Although patients and providers mostly agreed on implementation barriers and facilitators, several differences emerged. Taking both perspectives into account when using implementation frameworks is critical for expanding mobile health–based communication, especially as implementation requires active participation from providers and patients.

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Section: Discussionmentioning

confidence: 99%

Patient-Provider Text Messaging and Video Calling Among Case-Managed Patients Living With HIV: Formative Acceptability and Feasibility Study

Fonner¹,

Kennedy²,

Desai³

et al. 2021

JMIR Form Res

View full text Add to dashboard Cite

show abstract

“…The use of telehealth and related communication methods with patients can present challenges to the provision of health as identified by the research team, beyond this study. Important to note, disparities surrounding healthcare technologies (outside of just palliative care) do exist [ 22 ]. Specific challenges may include access to broadband internet in rural areas [ 22 , 23 ], socioeconomic factors [ 24 ], and even health literacy and education challenges [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

“…Important to note, disparities surrounding healthcare technologies (outside of just palliative care) do exist [ 22 ]. Specific challenges may include access to broadband internet in rural areas [ 22 , 23 ], socioeconomic factors [ 24 ], and even health literacy and education challenges [ 25 ]. These challenges and others are to be continuously addressed to help enable technology, an identified review construct in this study, to support the continuity of palliative care.…”

Section: Discussionmentioning

confidence: 99%

Provision of Palliative Care during the COVID-19 Pandemic: A Systematic Review of Ambulatory Care Organizations in the United States

et al. 2021

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Background and objectives: Ambulatory (outpatient) healthcare organizations continue to respond to the COVID-19 global pandemic using an array of initiatives to sustain a continuity of palliative care. Continuance of palliative care during major crises has been previously accomplished; however, the global pandemic presents new challenges to the US healthcare industry. Materials and methods: This systematic review queried four research databases to identify applicable studies related to the provision of palliative care during the pandemic in outpatient organizations within the United States. Results: There are two primary facilitators for the ongoing provision of palliative care for the outpatient segment of the United States healthcare industry: technology and advanced care planning. Researchers also identified two primary barriers in the outpatient setting impacting the continuance of palliative care: lack of resources and accessibility to care. Conclusions: This systematic review identified facilitators and barriers for palliative care initiatives in the United States that can further assist future outpatient (ambulatory care) providers at a global level as the pandemic and associated public health initiatives continue.

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“…Our sample predominantly consisted of African American patients, which reflects the racial makeup of the clinic population more generally and the disproportionate burden of HIV found among this group. Contributing to this limitation, our sample size was relatively small, and we were unable to tease out the differences in patient perspectives by specific characteristics, such as age, race, and place of residence (urban vs rural), despite known disparities in technology use across such factors [47][48][49]. This limitation also highlights the need to recognize that preferences for communication differ among individuals, and allowing choice is important.…”

Section: Limitationsmentioning

confidence: 94%

Patient-Provider Text Messaging and Video Calling Among Case-Managed Patients Living With HIV: Formative Acceptability and Feasibility Study (Preprint)

Fonner¹,

Kennedy²,

Desai³

et al. 2020

Preprint

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BACKGROUND Patient-provider communication is critical for engaging and retaining people living with HIV in care, especially among medically case-managed patients in need of service coordination and adherence support. Expanding patient-provider communication channels to include mobile health modalities, such as text messaging and video calling, has the potential to facilitate communication and ultimately improve clinical outcomes. However, the implementation of these communication modalities in clinical settings has not been well characterized. OBJECTIVE The purpose of this study is to understand patient and provider perspectives on the acceptability of and preferences for using text messaging and video calling as a means of communication; perceived factors relevant to adoption, appropriateness, and feasibility; and organizational perspectives on implementation within an HIV clinic in South Carolina. METHODS We conducted 26 semistructured in-depth interviews among patients receiving case management services (n=12) and clinic providers (n=14) using interview guides and content analysis informed by the Proctor taxonomy of implementation outcomes and the Consolidated Framework for Implementation Research. Participants were purposefully sampled to obtain maximum variation in terms of age and gender for patients and clinic roles for providers. The data were analyzed using quantitative and qualitative content analyses. RESULTS Most patients (11/12, 92%) and providers (12/14, 86%) agreed that they should have the capacity to text message and/or video call each other. Although consensus was not reached, most preferred using a secure messaging app rather than standard text messaging because of the enhanced security features. Perceived benefits to adoption included the added convenience of text messaging, and potential barriers included the cost and access of smartphone-based technology for patients. From an organizational perspective, some providers were concerned that offering text messaging could lead to unreasonable expectations of instant access and increased workload. CONCLUSIONS Patients and providers perceived text messaging and video calling as acceptable, appropriate, and feasible and felt that these expanded modes of communication could help meet patients’ needs while being safe and not excessively burdensome. Although patients and providers mostly agreed on implementation barriers and facilitators, several differences emerged. Taking both perspectives into account when using implementation frameworks is critical for expanding mobile health–based communication, especially as implementation requires active participation from providers and patients. CLINICALTRIAL

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Telehealth, Rural America, and the Digital Divide

Cited by 35 publications

References 5 publications

Patient-Provider Text Messaging and Video Calling Among Case-Managed Patients Living With HIV: Formative Acceptability and Feasibility Study

Patient-Provider Text Messaging and Video Calling Among Case-Managed Patients Living With HIV: Formative Acceptability and Feasibility Study

Provision of Palliative Care during the COVID-19 Pandemic: A Systematic Review of Ambulatory Care Organizations in the United States

Patient-Provider Text Messaging and Video Calling Among Case-Managed Patients Living With HIV: Formative Acceptability and Feasibility Study (Preprint)

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