Understanding Barriers to Telemedicine Implementation in Rural Emergency Departments

Zachrison, Kori S; Boggs, Krislyn M.; Hayden, Emily M.; Espinola, Janice A.; Camargo, Carlos A.

doi:10.1016/j.annemergmed.2019.06.026

Cited by 76 publications

(72 citation statements)

References 6 publications

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“…Moreover, patients who are unable to utilize the required devices or participate in a telemedicine session unaided either because of old age, poor hearing, cognitive dysfunction, language barriers, or limited education which may require the assistance of a family member or caregiver, who may not be available (40,41). Finally, the use of telemedicine may be technically limited by poor phone and internet connectivity in rural areas (42,43).…”

Section: Practical Considerations and Limitations Of Telemedicinementioning

confidence: 99%

Telemedicine in Heart Failure During COVID-19: A Step Into the Future

Tersalvi

Winterton

Cioffi

et al. 2020

Front. Cardiovasc. Med.

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During the Coronavirus Disease 2019 worldwide pandemic, patients with heart failure are a high-risk group with potential higher mortality if infected. Although lockdown represents a solution to prevent viral spreading, it endangers regular follow-up visits and precludes direct medical assessment in order to detect heart failure progression and optimize treatment. Furthermore, lifestyle changes during quarantine may trigger heart failure decompensations. During the pandemic, a paradoxical reduction of heart failure hospitalization rates was observed, supposedly caused by patient reluctance to visit emergency departments and hospitals. This may result in an increased patient mortality and/or in more complicated heart failure admissions in the future. In this scenario, different telemedicine strategies can be implemented to ensure continuity of care to patients with heart failure. Patients at home can be monitored through dedicated apps, telephone calls, or devices. Virtual visits and forward triage screen the patients with signs or symptoms of decompensated heart failure. In-hospital care may benefit from remote communication platforms. After discharge, patients may undergo remote follow-up or telerehabilitation to prevent early readmissions. This review provides a comprehensive appraisal of the many possible applications of telemedicine for patients with heart failure during Coronavirus disease 2019 and elucidates practical limitations and challenges regarding specific telemedicine modalities.

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Section: Practical Considerations and Limitations Of Telemedicinementioning

confidence: 99%

Telemedicine in Heart Failure During COVID-19: A Step Into the Future

Tersalvi

Winterton

Cioffi

et al. 2020

Front. Cardiovasc. Med.

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“…Absence of pediatric EPs (paired with absence of overall EPs) will likely accelerate the use of physician assistants and nurse practitioners 19 , 20 and the increased use of alternative forms of emergency care, including telepediatrics. 21 , 22 …”

Section: Discussionmentioning

confidence: 99%

Evaluation of the 2020 Pediatric Emergency Physician Workforce in the US

et al. 2021

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IMPORTANCE Given the mortality disparities among children and adolescents in rural vs urban areas, the unique health care needs of pediatric patients, and the annual emergency department volume for this patient population, understanding the availability of pediatric emergency physicians (EPs) is important. Information regarding the available pediatric EP workforce is limited, however. OBJECTIVETo describe the demographic characteristics, training, board certification, and geographic distribution of the 2020 clinically active pediatric EP workforce in the US. DESIGN, SETTING, AND PARTICIPANTS This national cross-sectional study of the 2020 pediatric EP workforce used the American Medical Association Physician Masterfile database, which was linked to American Board of Medical Specialties board certification information. Self-reported training data in the database were analyzed to identify clinically active physicians who self-reported pediatric emergency medicine (EM) as their primary or secondary specialty. The Physician Masterfile data were obtained on March 11, 2020. MAIN OUTCOMES AND MEASURES The Physician Masterfile was used to identify all clinically active pediatric EPs in the US. The definition of EM training was completion of an EM program (inclusive of both an EM residency and/or a pediatric EM fellowship) or a combined EM program (internal medicine and EM, family medicine and EM, or pediatrics and EM). Physician location was linked and classified by county-level Urban Influence Codes. Pediatric EP density was calculated and mapped using US Census Bureau population estimates. RESULTS A total of 2403 clinically active pediatric EPs were working in 2020 (5% of all clinically active emergency physicians), of whom 1357 were women (56%) and the median (interquartile range) age was 46 (40-55) years. The overall pediatric EP population included 1718 physicians (71%) with EM training and 641 (27%) with pediatric training. Overall, 1639 (68%) were board certified in pediatric EM, of whom 1219 (74%) reported EM training and 400 (24%) reported pediatrics training. Nearly all pediatric EPs worked in urban areas (2369 of 2402 [99%]), and pediatric EPs in urban compared with rural areas were younger (median [interquartile range] age, 46 [40-55] years vs 59 [48-65] years). Pediatric EPs who completed their training 20 years ago or more compared with those who completed training more recently were less likely to work in urban settings (633 [97%] vs 0-4 years: 440 [99%], 5-9 years: 547 [99%], or 10-19 years: 723 [99%]; P = .006). Three states had 0 pediatric EPs (Montana, South Dakota, and Wyoming), and 3 states had pediatric EPs in only 1 county (Alaska, New Mexico, and North Dakota). Less than 1% of counties had 4 or more pediatric EPs per 100 000 population. CONCLUSIONS AND RELEVANCE This study found that almost all pediatric EPs worked in urban areas, leaving rural areas of the US with limited availability of pediatric emergency care. This finding may have profound implications for children and adolescents needing eme...

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“…21 Among rural EDs without telemedicine, cost was the most commonly cited barrier. 22 In non-ED settings, payment policy environment has been associated with telemedicine use. However, there has been little exploration of ED adoption over time, the role of policy in ED adoption, characteristics of EDs that are using it, how it is used, and how it impacts patient care and outcomes.…”

Section: Importancementioning

confidence: 99%

“…In 2016, 48% of US EDs reported receiving telemedicine services for patient care in their ED (ie, telemedicine receipt) 21 . Among rural EDs without telemedicine, cost was the most commonly cited barrier 22 . In non‐ED settings, payment policy environment has been associated with telemedicine use.…”

Section: Introductionmentioning

confidence: 99%

Factors associated with emergency department adoption of telemedicine: 2014 to 2018

et al. 2020

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Objective: Telemedicine is used by emergency departments (EDs) to connect patients with specialty consultation and resources not available locally. Despite its utility, uptake of telemedicine in EDs has varied. We studied characteristics associated with telemedicine adoption during a 4-year period. Methods: We analyzed data from the 2014 National Emergency Department Inventory (NEDI)-New England survey and follow-up data from 2016 and 2017 NEDI-USA and 2018 NEDI-New England surveys, with data from the Center for Connected Health Policy. Among EDs not using telemedicine in 2014, we examined characteristics associated with adoption by 2018. Results: Of the 159 New England EDs with available data, 80 (50%) and 125 (79%) reported telemedicine receipt in 2014 and 2018, respectively. Among the 79 EDs without telemedicine in 2014, academic EDs were less likely to adopt by 2018 (odds ratio, 0.12; 95% confidence interval, 0.03-0.46). State policy environment was not associated with likelihood of adoption. In 2018, all 7 freestanding EDs received telemedicine, whereas only 1 of 9 academic EDs (11%) did. Conclusions: Telemedicine use by EDs continues to grow rapidly and by 2018, >3 quarters of EDs in our sample were receiving telemedicine. From 2014 to 2018, the initiation of telemedicine receipt was less common among higher volume and academic EDs.

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Understanding Barriers to Telemedicine Implementation in Rural Emergency Departments

Cited by 76 publications

References 6 publications

Telemedicine in Heart Failure During COVID-19: A Step Into the Future

Telemedicine in Heart Failure During COVID-19: A Step Into the Future

Evaluation of the 2020 Pediatric Emergency Physician Workforce in the US

Factors associated with emergency department adoption of telemedicine: 2014 to 2018

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