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Turning Digital in Times of Crisis: A Values-Based Theory of Telehealth Adoption During the Covid-19 Pandemic
... However, it is not only technological drivers and aspects such as rising costs of the healthcare system triggered by demographic shifts in industrialized countries, but also the Covid pandemic that has fueled increasing digitalization and interest in digital transformation in healthcare (Dal Mas et al., 2023;Zulkifli, 2024). The use of technologies such as Corona apps, e.g., for contagion control and telemedicine, has been an essential pillar in navigating the crisis of national and global health and has further accelerated the adoption of digital technologies in healthcare (Bernardi, 2023;Urbaczewski & Lee, 2020). As digital transformation moves on, the key issue for organizations is to "transform or be transformed" (Carroll et al., 2023b), which is also the case for healthcare organizations. ...
As digital transformation progresses, research broadens its perspective to not only focus on the positive effects but also on the adverse impacts of the increasing use of digital technologies. Against this backdrop, the issue of being responsibly digital moves to the foreground in research and practice. The need for further research on the conceptualization of digital responsibility and its role in the context of digital transformation has been indicated by the literature. In this paper, we empirically investigate the interplay of digital responsibility and digital transformation in the context of large-scale digital transformation. Based on our results, we derive four core contributions for IS theory as we highlight the prime role of digital responsibility in contemporary digital transformation processes, refine the conceptualization of digital responsibility in the context of digital transformation, propose six dynamic interplays of digital responsibility and digital transformation, and present promising avenues for further research on this increasingly relevant phenomenon.
... In healthcare supply chain management, artificial intelligence (AI), blockchain, big data analysis, and simulation have become the most important technologies, which can optimize the allocation of medical resources and ensure the continuity of basic health services. In addition, the isolation and lockdown measures of the COVID-19 pandemic have also prompted communities to adopt telemedicine [52], and digital devices have played an important role in patient clinical care or social contact [53], contact tracking and monitoring [54], telephone or video consultations [55], and mental health treatment [56]. Digital emergency is expected to play a greater role in the future, and even after face-to-face services are restored, telemedicine can still be considered as an option. ...
(1) Background: With the acceleration of globalization, various risks are intertwined and coupled, and community emergency management is facing greater pressure than before. The continuous development of digital technology has made it possible to empower community emergency management with digital technology. Therefore, it is urgent to have a clear understanding of the research status and future development direction of digital empowering community emergency management. (2) Methods: This study is based on the Web of Science database and utilizes the CiteSpace knowledge graph visualization method to analyze the research progress of community digital emergency management. (3) Results: The results indicate that from 2000 to 2024, the amount of research on community digital emergency management has been on the rise, involving multiple disciplines, but there has not been a close and mature cooperation network between different countries, institutions, and authors. The research topic has shifted from early single-emergency management to integration with emerging science and technology, with a greater emphasis on the role of communities. Big data, machine learning, technological innovation, digital healthcare, and community resilience are important research directions for the future. (4) Conclusions: In the future, we should strengthen cooperation in this field, overcome issues such as the digital divide and digital security, and promote further development of community digital emergency management.
... Digital transformation in companies is considered a means of change management in business in the works by Ji et al. (2023), Sabri (2023), Wang and Han (2023), and Yang and Deng (2023). Bernardi (2023), Sakas et al. (2023) and Zia et al. (2023) emphasize the increased significance and intensification of digitalization for change management in the conditions of the COVID-19 pandemic and crisis; • Change management is a business adaptation process to the market situation change through flexibility (Hendrickson & Henrysson, 2023;Krejci & Vogel, 2023). The result of change management in business is expressed in the growth of disposable income (Ben Halima et al., 2023) and the strengthening of image abroad or branding (Burmann et al., 2015); • A black swan event (black swan) in the economy is an unexpected event (crisis), characterized by a very high level of uncertainty and considerable depth of the situation, which predetermines the details of crisis management (Barwińska-Małajowicz et al., 2023;Bufalo et al., 2023). ...
This paper aims to explore the extent to which digitalization can be utilized as a change management tool during black swan events. This article explores how digitalization can help businesses adapt to black swan events like the COVID-19 pandemic and examines the correlation between digitalization growth rates, income, and brand strength in 30 countries with varying viral threats from 2018 to 2021. This paper compares digitalization’s impact on change management success in two different contexts. The first context is regular business events that occurred pre-pandemic, as measured by revenue stability and brand strength. The second context is the COVID-19 pandemic and crisis, considered a black swan event. The paper explains the difference in impact and how digitalization can contribute to change management success in both contexts. Our approach to crisis management considers the Black Swan Theory and change management offers a unique and valuable perspective. We found that digitalization can enhance business resilience during the pandemic, although we caution that the benefits of digitalization may be limited to the short term due to its flexibility. Due to consideration of the COVID-19 crisis as a black swan type, this paper clarified the accessibility of digitalization as a measure of crisis management and the scale of the anti-crisis effect of digitalization as a tool of flexibility and adaptation to the black swan.
... The ability of IT to adapt to changes, so important due to the lack of stability of the environment, is still underrepresented. Bernardi (2023) in research on the implementation of innovative telehealth solutions during the crisis caused by the Covid pandemic, showed the benefits that resulted from IT adaptability to ensure public safety. ...
Purpose: The aim of this research is to verify whether the characteristics of the environment are strengthening the influence of IT adaptability on organizational performance. Design/methodology/approach: In order to verify the potential relations, empirical studies were conducted in 1160 organizations located in Poland, Italy, and the USA. The CAWI method was used in this research, while the companies were selected on the basis of the purposive manner. The reliability of the scales used in the survey was tested and afterwards the moderation model was built, confirming the presumed relationships between the variables. Findings: It has been proven that the more VUCA the environment is, the stronger the influence of IT adaptability on organizational performance. Research limitations/implications: The limitations of the research include: performing analyzes only in three countries, purposeful sampling, data collection period, and the application of selected constructs to the model. The future studies proposals included in the article are aimed at reducing cognitive space. Practical implications: Research results can support organizational managers who, by ensuring IT with appropriate characteristics (such as IT adaptability), can enhance organizational performance in turbulent and difficult environmental conditions. Originality/value: The research enriches existing knowledge in the field of organizational performance. Including the issue of IT adaptability in considerations in this area allows for providing support to organizations operating in conditions of uncertainty.
As firms are moving towards data-driven decision making, they are facing an emerging problem, namely, algorithmic bias. Accordingly, algorithmic systems can yield socially-biased outcomes, thereby compounding inequalities in the workplace and in society. This paper reviews, summarises, and synthesises the current literature related to algorithmic bias and makes recommendations for future information systems research. Our literature analysis shows that most studies have conceptually discussed the ethical, legal, and design implications of algorithmic bias, whereas only a limited number have empirically examined them. Moreover, the mechanisms through which technology-driven biases translate into decisions and behaviours have been largely overlooked. Based on the reviewed papers and drawing on theories such as the stimulus-organism-response theory and organisational justice theory, we identify and explicate eight important theoretical concepts and develop a research model depicting the relations between those concepts. The model proposes that algorithmic bias can affect fairness perceptions and technology-related behaviours such as machine-generated recommendation acceptance, algorithm appreciation, and system adoption. The model also proposes that contextual dimensions (i.e., individual, task, technology, organisational, and environmental) can influence the perceptual and behavioural manifestations of algorithmic bias. These propositions highlight the significant gap in the literature and provide a roadmap for future studies.
Against the backdrop of a global pandemic, this study investigates how U.S. higher education leaders have centered their crisis management on values and guiding ethical principles. We conducted 55 in-depth interviews with leaders from 30 U.S. higher education institutions, with most leaders participating in two interviews. We found that crisis plans created prior to the COVID-19 pandemic were inadequate due to the long duration and highly uncertain nature of the crisis. Instead, higher education leaders applied guiding principles on the fly to support their decision-making. If colleges and universities infuse shared values into their future crisis plans, they will not have to develop a moral compass on the fly for the next pandemic. This paper suggests the following somewhat universal shared values: (1) engage in accuracy, transparency, and accountability; (2) foster deliberative dialog; (3) prioritize safety; (4) support justice, fairness, and equity; and (5) engage in an ethic of care. To navigate ethics tensions, leaders need to possess crisis-relevant expertise or ensure that such expertise is present among crisis management team members. Standing up formal ethics committees composed of diverse stakeholders also is instrumental in navigating tensions inherent in crises. The next pandemic is already on the horizon according to experts. Through infusing values into future crisis plans, higher education leaders can be confident that their responses will be grounded in their communities’ shared values.
Prior to the COVID-19 pandemic, studies in the US have identified wide variations in telehealth use across medical specialties. This is an intriguing problem, because the US has historically lacked a standardized set of telehealth coverage and reimbursement policies, which has posed a barrier to telehealth use across all specialties. Although all medical specialties in the US have been affected by these macro (policy-level) barriers, some specialties have been able to integrate telehealth use into mainstream practice, while others are just gaining momentum with telehealth during COVID-19. Although the temporary removal of policy (coverage) restrictions during the pandemic has accelerated telehealth use, uncertainties remain regarding future telehealth sustainability. Since macro (policy-level) factors by themselves do not serve to explain the variation in telehealth use across specialties, it would be important to examine meso (organizational-level) and micro (individual-level) factors historically influencing telehealth use across specialties, to understand underlying reasons for variation and identify implications for widespread sustainability. This paper draws upon the existing literature to develop a conceptual framework on macro-meso-micro factors influencing telehealth use within a medical specialty. The framework is then used to guide a narrative review of the telehealth literature across six medical specialties, including three specialties with lower telehealth use (allergy-immunology, family medicine, gastroenterology) and three with higher telehealth use (psychiatry, cardiology, radiology) in the US, in order to synthesize themes and gain insights into barriers and facilitators to telehealth use. In doing so, this review addresses a gap in the literature and provides a foundation for future research. Importantly, it helps to identify implications for ensuring widespread sustainability of telehealth use in the post-pandemic future.
Objective
: To overcome obstacles to delivering medication abortion services during the COVID-19 pandemic, clinics and providers implemented new medication abortion service models not requiring in-person care. This study identifies organizational factors that promoted successful implementation of telehealth and adoption of “no test” medication abortion protocols.
Study Design
: We conducted 21 semi-structured, in-depth interviews with healthcare providers and clinic administrators implementing clinician-supported telehealth abortion during the COVID pandemic. We selected 15 clinical sites to represent four different practice settings: independent primary care practices, online medical services, specialty family planning clinics, and primary care clinics within multispecialty health systems. The Consolidated Framework for Implementation Research (CFIR) guided our thematic analysis.
Results
: Successful implementation of telehealth abortion included access to formal and informal inter-organizational networks, including professional organizations and informal mentorship relationships with innovators in the field; organizational readiness for implementation, such as having clinic resources available for telehealth services like functional electronic health records and options for easy-to-use virtual patient-provider interactions; and motivated and effective clinic champions.
Conclusions
: In response to the need to offer remote clinical services, four different practice settings types leveraged key operational factors to facilitate successful implementation of telehealth abortion. Information from this study can inform implementation strategies to support the dissemination and adoption of this model.
Implications
: Examples of successfully implemented telehealth medication abortion services provide a framework that can be used to inform and implement similar patient-centered telehealth models in diverse practice settings.
The COVID-19 pandemic has taken the mental health system by surprise, with the state of lockdown forcing businesses to close their doors, including many mental health services. This has driven many psychotherapists and other mental health professionals towards telepsychotherapy, relying on online consultations to provide continuity of care. However, the adoption of telepsychotherapy required major adaptations from both mental health professionals and patients. This study set out to explore the predictors of the use of online consultations and the perceived level of comfort using telepsychotherapy in a sample of 73 Lebanese mental health professionals. Data was collected via online dissemination of a survey. Results show that 82% of participants made use of online consultations in the past few days, reflecting the adaptation of Lebanese mental health professionals to the atypical newly imposed situation triggered by the COVID-19 pandemic and its consequent lockdown. Having previous experience in the use of online consultations and perceived level of telepresence were significant predictors of the level of comfort of mental health professionals in the execution online consultations. We suggest that more awareness and trainings are required around the practice of telepsychotherapy outside the context of the COVID-19 pandemic.
The measures adopted by governments around the world to control the spread of the COVID-19 virus (e.g., social distancing) have propelled a rapid transition from face-to-face to online therapy. Studies on online individual therapy indicate that therapists often have favorable attitudes toward this modality. To date, there is scant work on couples therapists’ attitudes, despite the fact that the provision of online couples’ therapy poses unique challenges (e.g., dealing with escalating conflict remotely). To provide a snapshot, in real time, as to how therapists experience the transition to online therapy, we surveyed 166 Israeli couples’ therapists during April 2020, when lockdown orders prevented therapists from seeing couples face-to-face. A few weeks later, when the stay-at-home policy was lifted, a subsample (N = 60) of these therapists completed a follow-up assessment. The results suggest that couples therapists had limited experience using the online modality prior to COVID. The therapists reported experiencing online couples’ therapy as somewhat successful and that their experience of providing therapy during the COVID-19 crisis had an overall positive impact on their attitudes toward online work. Establishing a strong therapeutic bond with both partners, dealing with escalating conflict, and treatment dropout were identified as the issues of most concern when conducting online couples therapy. The perceived difficulties with online therapy prospectively predicted lower usage of online couples’ therapy, as well as less intention to continue online treatment once the crisis is over.
Telemedicine has rapidly expanded in many aspects of pediatric care as a result of the COVID-19 pandemic. However, little is known about what factors may make pediatric subspeciality care more apt to long-term adoption of telemedicine. To better delineate the potential patient, provider, and subspecialty factors which may influence subspecialty adoption of telemedicine, we reviewed our institutional experience. The top 36 pediatric subspecialties at Stanford Children's Health were classified into high telemedicine adopters, low telemedicine adopters, and telemedicine reverters. Distance from the patient's home, primary language, insurance type, institutional factors such as wait times, and subspecialty-specific clinical differences correlated with differing patterns of telemedicine adoption. With greater awareness of these factors, institutions and providers can better guide patients in determining which care may be best suited for telemedicine and develop sustainable long-term telemedicine programming.
Background
The emergence of the COVID-19 pandemic has raised concerns about the potential decrease in access and utilisation of general practice services and its impact on patient care. In March 2020, the Australian Government introduced telehealth services to ensure that people more vulnerable to COVID-19 do not delay routine care from their general practitioners. Evidence about patients’ experience of telehealth and its impact on patient care is scarce. This study aimed to investigate the experience with telehealth by Australian general practice patients at high risk of poor health outcomes during the COVID-19 pandemic.
Methods
Semi-structured telephone interviews were conducted with 30 patients from nine general practices in metropolitan Adelaide (May–June 2020). Participants were identified by their regular doctor as being at high risk of poor health outcomes. Interviews sought participants’ perspectives and experiences about telehealth services in the general practice setting during COVID-19, and the value of offering continued telehealth services post pandemic. Interviews were recorded and transcribed verbatim. Data were analysed using a coding structure developed based on deductive codes derived from the research questions and any additional concepts that emerged inductively from interviews.
Results
Participants expressed satisfaction with telehealth including convenient and timely access to general practice services. Yet, participants identified challenges including difficulties in expressing themselves and accessing physical exams. Prescription renewal, discussing test results and simple follow-ups were the most common reasons that telehealth was used. Telehealth was mainly via phone that better suited those with low digital literacy. Participants indicated that an existing doctor-patient relationship was important for telehealth services to be effective. Subjects believed that telehealth services should be continued but needed to be combined with opportunities for face-to-face consultations after the COVID-19 pandemic was over.
Conclusions
The expansion of telehealth supported access to general practice including chronic disease management during the COVID-19 pandemic. In the future, telehealth in Australia is likely to have a stronger place in primary healthcare policy and practice and an increased acceptance amongst patients.
Background
Los Angeles County is a hub for COVID-19 cases in the United States. Academic health centers rapidly deployed and leveraged telemedicine to permit uninterrupted care of patients. Telemedicine enjoys high patient satisfaction, yet little is known about the level of satisfaction during a crisis and to what extent patient- or visit-related factors and trust play when in-person visits are eliminated.
Objective
The aim of this study is to examine correlates of patients’ satisfaction with a telemedicine visit.
Methods
In this retrospective observational study conducted in our single-institution, urban, academic medical center in Los Angeles, internal medicine patients aged ≥18 years who completed a telemedicine visit between March 10th and April 17th, 2020, were invited for a survey (n=1624). Measures included patient demographics, degree of interpersonal trust in patient-physician relationships (using the Trust in Physician Scale), and visit-related concerns. Statistical analysis used descriptive statistics, Spearman rank-order correlation, and linear and ordinal logistic regression.
ResultsOf 1624 telemedicine visits conducted during this period, 368 (22.7%) patients participated in the survey. Across the study, respondents were very satisfied (173/365, 47.4%) or satisfied (n=129, 35.3%) with their telemedicine visit. Higher physician trust was associated with higher patient satisfaction (Spearman correlation r=0.51, P
Background
There is a paucity of evidence for the implementation of remote home monitoring for COVID-19 infection. The aims of this study were to identify the key characteristics of remote home monitoring models for COVID-19 infection, explore the experiences of staff implementing these models, understand the use of data for monitoring progress against outcomes, and document variability in staffing and resource allocation.
Methods
This was a multi-site mixed methods study conducted between July and August 2020 that combined qualitative and quantitative approaches to analyse the implementation and impact of remote home monitoring models developed during the first wave of the COVID-19 pandemic in England. The study combined interviews (n = 22) with staff delivering these models across eight sites in England with the collection and analysis of data on staffing models and resource allocation.
Findings
The models varied in relation to the healthcare settings and mechanisms used for patient triage, monitoring and escalation. Implementation was embedded in existing staff workloads and budgets. Good communication within clinical teams, culturally-appropriate information for patients/carers and the combination of multiple approaches for patient monitoring (app and paper-based) were considered facilitators in implementation. The mean cost per monitored patient varied from £400 to £553, depending on the model.
Interpretation
It is necessary to provide the means for evaluating the effectiveness of these models, for example, by establishing comparator data. Future research should also focus on the sustainability of the models and patient experience (considering the extent to which some of the models exacerbate existing inequalities in access to care).
Traditionally, Web of Science and Scopus have been the two most widely used databases for bibliometric analyses. However, during the last few years some new scholarly databases, such as Dimensions, have come up. Several previous studies have compared different databases, either through a direct comparison of article coverage or by comparing the citations across the databases. This article aims to present a comparative analysis of the journal coverage of the three databases (Web of Science, Scopus and Dimensions), with the objective to describe, understand and visualize the differences in them. The most recent master journal lists of the three databases is used for analysis. The results indicate that the databases have significantly different journal coverage, with the Web of Science being most selective and Dimensions being the most exhaustive. About 99.11% and 96.61% of the journals indexed in Web of Science are also indexed in Scopus and Dimensions, respectively. Scopus has 96.42% of its indexed journals also covered by Dimensions. Dimensions database has the most exhaustive journal coverage, with 82.22% more journals than Web of Science and 48.17% more journals than Scopus. This article also analysed the research outputs for 20 selected countries for the 2010–2018 period, as indexed in the three databases, and identified database-induced variations in research output volume, rank, global share and subject area composition for different countries. It is found that there are clearly visible variations in the research output from different countries in the three databases, along with differential coverage of different subject areas by the three databases. The analytical study provides an informative and practically useful picture of the journal coverage of Web of Science, Scopus and Dimensions databases.
The present study was designed to assess mental health provider attitudes and perceptions of telemental health (TMH) prior to and during the COVID-19 Pandemic, as well as the nature of their TMH utilization. The study aimed to gather information about positive and negative attitudes towards TMH, perceptions and correlates based on the modality of care, and beliefs about the overall effectiveness of TMH as compared to face-to-face care. The current study is part of a larger mixed methods project utilizing a repeated cross-sectional design. An online survey was administered to a sample of 1448 mental health providers and included demographic and professional information, experiences with and perceptions of TMH prior to and during the COVID-19 Pandemic, as well as a brief measure of pandemic-related stress. The COVID-19 Pandemic resulted in an increased use of TMH in the study sample. During COVID-19, providers reported increased agreement with TMH being necessary, important, and effective for care delivery. Providers who primarily used video, compared with telephone, reported that TMH was more useful, satisfying, and effective. While negative attitude towards TMH was predicted only by prior attitudes and belief in TMH effectiveness, positive attitude towards TMH was also predicted by female sex and current level of pandemic related stress. TMH use during the pandemic was predicted by primary use of video platform and previous TMH use. The 2020 COVID-19 Pandemic resulted in increased use of TMH and significantly increased positive perceptions about TMH among mental health providers.
We live in a technologically advanced era with a recent and marked dependence on digital technologies while also facing increasingly frequent extreme and global crises. Crises, like the COVID-19 pandemic, are significantly impacting our societies, organizations and individuals and dramatically shifting the use of, and dependence on, digital technology. The way digital technology is used to cope with crises is novel and not well understood theoretically. To explore the varied uses and impact of digital technologies during crises, we propose to view crisis as (1) opportunity, (2) disruption, and (3) exposure. Examining crisis as opportunity reveals how digital technologies enable experimentation and accelerate innovation while raising coordination challenges and risky implementation. Viewing crisis as disruption highlights how digital technologies enable the rapid shifting of organizational and occupational practices to new digital spaces, allowing work continuity, yet potentially distorting work practices and raising challenges of over-dependence. Finally, crisis exposes the societal implications in making visible and exposing digital inequalities and producing moral dilemmas for us all. We use these three perspectives to shed light on the varied uses of digital technologies in the COVID-19 crisis and suggest new avenues for research on crises more broadly.
Objective
To explore orthopaedic and musculoskeletal clinicians’ views and experiences of legal, safety, safeguarding and security issues regarding the use of virtual consultations (VC) during the COVID-19 pandemic. A secondary objective was to suggest ways to overcome these issues.
Methods
A mixed method cross-sectional survey was conducted, seeking the views and experiences of orthopaedic and musculoskeletal medically qualified and Allied Health Professionals in the United Kingdom. Descriptive statistical analysis was employed for quantitative data and a qualitative content analysis undertaken for qualitative data. Findings were presented in accordance with the four key issues.
Results
Two hundred and ninety professionals (206 physiotherapists, 78 medically qualified professionals, 6 ‘other’ therapists) participated in the survey. Of the 290 participants, 260 (90%) were not using VC prior to the COVID-19 pandemic, 248 respondents (86%) were unsure whether their professional indemnity insurance covered VC, 136 (47%) had considered how they would handle an issue of safeguarding whilst the remainder had not, 126 (43%) had considered what they would do if, during a virtual consultation, a patient suffered an injury (e.g. bang on their head) or a fall (e.g. mechanical or a medical event like syncope) and 158 (54%) reported they felt the current technological solutions are secure in terms of patient data. Qualitative data provided additional context to support the quantitative findings such as validity of indemnification, accuracy of diagnosis and consent using VC, safeguarding issues; and security and sharing of data. Potential changes to practice have been proposed to address these issues.
Conclusions
VC have been rapidly deployed since the onset of the COVID-19 pandemic often without clear guidance or consensus on many important issues. This study identified legal, safeguarding, safety and security issues. There is an urgent need to address these and develop local and national guidance and frameworks to facilitate ongoing safe virtual orthopaedic practice beyond the COVID-19 pandemic.
Background: In Australia, telehealth services were used as an alternative method of health care delivery during the COVID-19 pandemic. Through a realist analysis of a survey of health professionals, we have sought to identify the underlying mechanisms that have assisted Australian health services adapt to the physical separation between clinicians and patients.
Methods: Using a critical realist ontology and epistemology, we undertook an online survey of health professionals subscribing to the Australian Telehealth Society newsletter. The survey had close- and open-ended questions, constructed to identify contextual changes in the operating environment for telehealth services, and assess the mechanisms which had contributed to these changes. We applied descriptive and McNemar's Chi-square analysis for the close-ended component of the survey, and a reflexive thematic analysis approach for the open-ended questions which were framed within the activity based funding system which had previously limited telehealth services to regional Australia.
Results: Of the 91 respondents most (73%) reported a higher volume of telephone-based care since COVID and an increase in use of video consultations (60% of respondents). Respondents felt that the move to provide care using telehealth services had been a “forced adoption” where clinicians began to use telehealth services (often for the first time) to maintain health care. Respondents noted significant changes in managerial and medical culture which supported the legitimisation of telehealth services as a mode of access to care. The support of leaders and the use personal and organisational networks to facilitate the operation of telehealth service were felt to be particularly valuable. Access to, and reliability of, the technology were considered extremely important for services. Respondents also welcomed the increased availability of more human and financial resources.
Conclusions: During the pandemic, mechanisms that legitimise practise, build confidence, support relationships and supply resources have fostered the use of telehealth. This ongoing interaction between telehealth services, contexts and mechanisms is complex. The adoption of telehealth access to enable physically separated care, may mark a “new context;” or it could be that once the pandemic passes, previous policies and practises will re-assert themselves and curb support for telehealth-enabled care.
Introduction
The COVID-19 pandemic has led to a rapid implementation of telemedicine for the provision of maternal and newborn healthcare. The objective of this study was to document the experiences with providing telemedicine for maternal and newborn healthcare during the pandemic among healthcare professionals globally.
Methods
The second round of a global online survey of maternal and newborn health professionals was conducted, disseminated in 11 languages. Data were collected between 5 July and 10 September 2020. The questionnaire included questions regarding background, preparedness and response to COVID-19, and experiences with providing telemedicine. Descriptive statistics and qualitative thematic analysis were used to analyse responses, disaggregated by country income level.
Results
Responses from 1060 maternal and newborn health professionals were analysed. Telemedicine was used by 58% of health professionals and two-fifths of them reported not receiving guidelines on the provision of telemedicine. Key telemedicine practices included online birth preparedness classes, antenatal and postnatal care by video/phone, a COVID-19 helpline and online psychosocial counselling. Challenges reported lack of infrastructure and technological literacy, limited monitoring, financial and language barriers, lack of non-verbal feedback and bonding, and distrust from patients. Telemedicine was considered as an important alternative to in-person consultations. However, health providers emphasised the lower quality of care and risk of increasing the already existing inequalities in access to healthcare.
Conclusions
Telemedicine has been applied globally to address disruptions of care provision during the COVID-19 pandemic. However, some crucial aspects of maternal and newborn healthcare seem difficult to deliver by telemedicine. More research regarding the effectiveness, efficacy and quality of telemedicine for maternal healthcare in different contexts is needed before considering long-term adaptations in provision of care away from face-to-face interactions. Clear guidelines for care provision and approaches to minimising socioeconomic and technological inequalities in access to care are urgently needed.
Widespread transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has resulted in a global coronavirus disease 2019 (COVID-19) pandemic that is straining medical resources worldwide. In the United States (US), hospitals and clinics are challenged to accommodate surging patient populations and care needs while preventing further infection spread. Under such conditions, meeting with patients via telehealth technology is a practical way to help maintain meaningful contact while mitigating SARS-CoV-2 transmission. The application of telehealth to nutrition care can, in turn, contribute to better outcomes and lower burdens on healthcare resources. To identify trends in telehealth nutrition care before and during the pandemic, we emailed a 20-question, qualitative structured survey to approximately 200 registered dietitian nutritionists (RDNs) from hospitals and clinics that have participated in the Malnutrition Quality Improvement Initiative (MQii). RDN respondents reported increased use of telehealth-based care for nutritionally at-risk patients during the pandemic. They suggested that use of such telehealth nutrition programs supported positive patient outcomes, and some of their sites planned to continue the telehealth-based nutrition visits in post-pandemic care. Nutrition care by telehealth technology has the potential to improve care provided by practicing RDNs, such as by reducing no-show rates and increasing retention as well as improving health outcomes for patients. Therefore, we call on healthcare professionals and legislative leaders to implement policy and funding changes that will support improved access to nutrition care via telehealth.
As COVID‐19 drags on and new vaccines promise widespread immunity, the world's attention has turned to predicting how the present pandemic will end. How do societies know when an epidemic is over and normal life can resume? What criteria and markers indicate such an end? Who has the insight, authority, and credibility to decipher these signs? Detailed research on past epidemics has demonstrated that they do not end suddenly; indeed, only rarely do the diseases in question actually end. This article examines the ways in which scholars have identified and described the end stages of previous epidemics, pointing out that significantly less attention has been paid to these periods than to origins and climaxes. Analysis of the ends of epidemics illustrates that epidemics are as much social, political, and economic events as they are biological; the “end,” therefore, is as much a process of social and political negotiation as it is biomedical. Equally important, epidemics end at different times for different groups, both within one society and across regions. Multidisciplinary research into how epidemics end reveals how the end of an epidemic shifts according to perspective, whether temporal, geographic, or methodological. A multidisciplinary analysis of how epidemics end suggests that epidemics should therefore be framed not as linear narratives—from outbreak to intervention to termination—but within cycles of disease and with a multiplicity of endings. Open access at https://onlinelibrary.wiley.com/doi/10.1111/1600-0498.12370
Introduction
Due to the pandemic of COVID-19 a number of National Health Service (NHS) Trusts in the UK adopted telephone consultations for patients who were shielding. As the pandemic continues to affect these services an evaluation was conducted to determine whether telephone consultations implemented during the pandemic should be maintained long term. The objective was to evaluate this new service and to understand patient experience.
Methods
This study was conducted via a telephone survey. Staff working in the Macmillan centres across the Trust called patients to survey them about their experience of telephone consultations. Data were collected 23/06/20 – 17/07/20. A mix of eight open and closed questions were asked. Data were collected on an Excel spreadsheet and patient identifiable information was anonymised.
Results
55 patients accepted to participate in this study. Out of 55, 39 patients rated the phone consultation they had as either 4 or 5 out of 5. When asked if they would like to continue with phone clinics 33 said they would. The majority of consultations were conducted by doctors (43/55). Patients commented they had received great support from their healthcare professionals and they felt that phone consultations were safer in the current climate. Three of the patients felt the calls were rushed and others found it difficult to discuss pain management, sides effects and post-surgery issues.
Conclusions
This evaluation provides a brief snapshot of the experience cancer patients are having with phone clinics. A re-evaluation will take place once video consultations are implemented.
Background
Adopting a better understanding of how both older adults and health care providers view the community management of frailty is necessary for improving home health, especially facing the coronavirus disease 2019 (COVID‐19) pandemic. We conducted a qualitative focus group study to assess how both older adults and health care providers view frailty and virtual health care in home health.
Methods
Two focus groups enrolled home‐living older adults and health care professionals, respectively (n = 15). Questions targeting the use of virtual / telehealth technologies in‐home care for frail older adults were administered at audio‐recorded group interviews. Transcribed discussions were coded and analyzed using NVivo software.
Results
The older adult group emphasized the autonomy related to increasing frailty and social isolation and the need for transparent dissemination of health care planning. They were optimistic about remote technology‐based supports and suggested that telehealth / health‐monitoring/tracking were in high demand. Health care professionals emphasized the importance of a holistic biopsychosocial approach to frailty management. They highlighted the need for standardized early assessment and management of frailty.
Conclusions
The integrated perspectives provided an updated understanding of what older adults and practitioners value in home‐living supports. This knowledge is helpful to advancing virtual home care, providing better care for frail individuals with complex health care needs.
Background
To minimize the spread and risk of a COVID-19 outbreak, societal norms have been challenged with respect to how essential services are delivered. With pressures to reduce the number of in-person ambulatory visits, innovative models of telemonitoring have been used during the pandemic as a necessary alternative to support access to care for patients with chronic conditions. The pandemic has led health care organizations to consider the adoption of telemonitoring interventions for the first time, while others have seen existing programs rapidly expand.
Objective
At the Toronto General Hospital in Ontario, Canada, the rapid expansion of a telemonitoring program began on March 9, 2020, in response to COVID-19. The objective of this study was to understand the experiences related to the expanded role of a telemonitoring program under the changing conditions of the pandemic.
Methods
A single-case qualitative study was conducted with 3 embedded units of analysis. Semistructured interviews probed the experiences of patients, clinicians, and program staff from the Medly telemonitoring program at a heart function clinic in Toronto, Canada. Data were analyzed using inductive thematic analysis as well as Eakin and Gladstone’s value-adding approach to enhance the analytic interpretation of the study findings.
Results
A total of 29 participants were interviewed, including patients (n=16), clinicians (n=9), and operational staff (n=4). Four themes were identified: (1) providing care continuity through telemonitoring; (2) adapting telemonitoring operations for a more virtual health care system; (3) confronting virtual workflow challenges; and (4) fostering a meaningful patient-provider relationship. Beyond supporting virtual visits, the program’s ability to provide a more comprehensive picture of the patient’s health was valued. However, issues relating to the lack of system integration and alert-driven interactions jeopardized the perceived sustainability of the program.
Conclusions
With the reduction of in-person visits during the pandemic, virtual services such as telemonitoring have demonstrated significant value. Based on our study findings, we offer recommendations to proactively adapt and scale telemonitoring programs under the changing conditions of an increasingly virtual health care system. These include revisiting the scope and expectations of telemedicine interventions, streamlining virtual patient onboarding processes, and personalizing the collection of patient information to build a stronger virtual relationship and a more holistic assessment of patient well-being.
Importance
Telehealth has emerged as a means of improving access and reducing cost for medical oncology care; however, use by specialists prior to the coronavirus disease 2019 (COVID-19) pandemic still remained low. Medical oncology professionals’ perceptions of telehealth for cancer care are largely unknown, but are critical to telehealth utilization and expansion efforts.
Objective
To identify medical oncology health professionals’ perceptions of the barriers to and benefits of telehealth video visits.
Design, Setting, and Participants
This qualitative study used interviews conducted from October 30, 2019, to March 5, 2020, of medical oncology health professionals at the Thomas Jefferson University Hospital, an urban academic health system in the US with a cancer center. All medical oncology physicians, physicians assistants, and nurse practitioners at the hospital were eligible to participate. A combination of volunteer and convenience sampling was used, resulting in the participation of 29 medical oncology health professionals, including 20 physicians and 9 advanced practice professionals, in semistructured interviews.
Main Outcomes and Measures
Medical oncology health professionals’ perceptions of barriers to and benefits of telehealth video visits as experienced by patients receiving cancer treatment.
Results
Of the 29 participants, 15 (52%) were women and 22 (76%) were White, with a mean (SD) age of 48.5 (12.0) years. Respondents’ perceptions were organized using the 4 domains of the National Quality Forum framework: clinical effectiveness, patient experience, access to care, and financial impact. Respondents disagreed on the clinical effectiveness and potential limitations of the virtual physical examination, as well as on the financial impact on patients. Respondents also largely recognized the convenience and improved access to care enabled by telehealth for patients. However, many reported concern regarding the health professional–patient relationship and their limited ability to comfort patients in a virtual setting.
Conclusions and Relevance
Medical oncology health professionals shared conflicting opinions regarding the barriers to and benefits of telehealth in regard to clinical effectiveness, patient experience, access to care, and financial impact. Understanding oncologists’ perceptions of telehealth elucidates potential barriers that need to be further investigated or improved for telehealth expansion and continued utilization; further research is ongoing to assess current perceptions of health professionals and patients given the rapid expansion of telehealth during the COVID-19 pandemic.
Importance
The coronavirus disease 2019 (COVID-19) pandemic has burdened health care resources and disrupted care of patients with cancer. Virtual care (VC) represents a potential solution. However, few quantitative data support its rapid implementation and positive associations with service capacity and quality.
Objective
To examine the outcomes of a cancer center–wide virtual care program in response to the COVID-19 pandemic.
Design, Setting, and Participants
This cohort study applied a hospitalwide agile service design to map gaps and develop a customized digital solution to enable at-scale VC across a publicly funded comprehensive cancer center. Data were collected from a high-volume cancer center in Ontario, Canada, from March 23 to May 22, 2020.
Main Outcomes and Measures
Outcome measures were care delivery volumes, quality of care, patient and practitioner experiences, and cost savings to patients.
Results
The VC solution was developed and launched 12 days after the declaration of the COVID-19 pandemic. A total of 22 085 VC visits (mean, 514 visits per day) were conducted, comprising 68.4% (range, 18.8%-100%) of daily visits compared with 0.8% before launch (P < .001). Ambulatory clinic volumes recovered a month after deployment (3714-4091 patients per week), whereas chemotherapy and radiotherapy caseloads (1943-2461 patients per week) remained stable throughout. No changes in institutional or provincial quality-of-care indexes were observed. A total of 3791 surveys (3507 patients and 284 practitioners) were completed; 2207 patients (82%) and 92 practitioners (72%) indicated overall satisfaction with VC. The direct cost of this initiative was CAD 3 155 946.
Conclusions and Relevance
These findings suggest that implementation of VC at scale at a high-volume cancer center may be feasible. An agile service design approach was able to preserve outpatient caseloads and maintain care quality, while rendering high patient and practitioner satisfaction. These findings may help guide the transformation of telemedicine in the post COVID-19 era.
Objective: To explore professionals', adult patients', and children's caregivers' perception and satisfaction with telerehabilitation during COVID-19 lockdown.
Design: An observational transversal study on a web-based survey was conducted in order to explore participants' perception and satisfaction of telerehabilitation during COVID-19 lockdown.
Setting: The study was conducted at our Outpatient Neurorehabilitation Service.
Subjects: All rehabilitation professionals, adult patients, and children's caregivers who accepted telerehabilitation were recruited.
Interventions: Participants had to respond to the Client Satisfaction Questionnaire-8 and to a purpose-built questionnaire on their perception and satisfaction of the service provided.
Main Measures: Data were analyzed by qualitative statistics and logistic regression models.
Results: All 144 caregivers, 25 adult patients, and 50 professionals reported a medium-high level of perception and a high level of satisfaction. Results showed a correlation among caregivers of children aged 0–3 and feeling overwhelmed with remote care (OR = 3.27), a low perception of telerehabilitation for enhancing goals (OR = 6.51), and a high perception of feeling helped in organizing daily activity (OR = 2.96). For caregivers of children aged over 6 years, changes in the therapy plan were related to a low perception of feeling in line with the in-person therapy (OR = 2.61 and OR = 9.61) and a low satisfaction (OR = 5.54 and OR = 4.97). Changes in therapy were related to concern (OR = 4.20). Caregivers under 40 and professionals showed a high probability to perceive telerehabilitation as supportive (OR = 2.27 and OR = 5.68). Level of experience with remote media was shown to influence perception and satisfaction.
Interpretation: Telerehabilitation can be a useful practice both during a health emergency and in addition to in-presence therapy.
Background:
Covid-19 has thrust video consulting into the limelight, as health care practitioners around the world shift to delivering care remotely. Evidence suggests that video consulting is acceptable, safe and effective in selected conditions and settings. However, research to date has mostly focused on initial adoption with limited consideration of how video consulting can be mainstreamed and sustained.
Objective:
The study sought to (a) review and synthesize reported opportunities, challenges and lessons learnt in the scale-up, spread, and sustainability of video consultations, and (b) identify transferable insights that can inform policy and practice.
Methods:
We identified papers through systematic searches in PubMed, CINAHL and Web of Science. Included articles reported on synchronous, video-based consultations that had spread to more than one setting beyond an initial pilot or feasibility stage, and were published since 2010. We used the Non-adoption, Abandonment, and challenges to the Scale-up, Spread, and Sustainability (NASSS) framework to synthesise findings relating to 7 domains: an understanding of the health condition(s) for which video consultations were being used, the material properties of the technological platform and relevant peripherals, the value proposition for patients and developers, the role of the adopter system, organisational factors, wider macro-level considerations, as well as emergence over time.
Results:
We identified 13 papers describing 10 different video consultation services in 6 regions, covering (i) video-to-home services, connecting providers directly to the patient; (ii) hub-and-spoke models, connecting a provider at a central hub to a patient at a rural centre; and (iii) large-scale top-down evaluations scaled-up or spread across a national health administration. Services covered rehabilitation, geriatrics, cancer surgery, diabetes, and mental health, and general specialist care and primary care. Potential enablers to spread and scale-up included embedded leadership and the presence of a telehealth champion, appropriate reimbursement mechanisms, user-friendly technology, pre-existing staff relationships, and adaptation (of technology and services) over time. Challenges tended to focus on service development, such as the absence of a long-term strategic plan, resistance to change, cost and reimbursement issues and technical experience of staff. There was limited articulation of the challenges to scale-up and spread of video consultations. This was combined with a lack of theorization, with papers tending to view spread and scale-up as the sum of multiple technical implementations, rather than theorising the distinct processes required to achieve widespread adoption.
Conclusions:
There remains a significant lack of evidence that can support spread and scale-up of video consulting. Given the recent pace of change due to Covid-19, a more definitive evidence base is urgently needed that can support global efforts and match enthusiasm for extending use.
Clinicaltrial:
Introduction
Telehealth and its usage strongly depend on regulatory frameworks and user acceptance. During the COVID-19 pandemic, physiotherapists, occupational therapists, speech-language therapists and their patients experienced restrictions regarding the usual face-to-face therapy. Teletherapy has become a highly discussed medium for providing therapy services. This study aimed at assessing Austrian therapists’ attitudes towards teletherapy, including perceived barriers, during and before the COVID-19 lockdown. Further interest referred to therapists’ technical affinity and experiences with the application of teletherapy.
Methods
Therapists (n = 325) completed an online survey amid the COVID-19 lockdown in 2020. Retrospective indications referred to the time prior to the lockdown. Ratings were opposed across the three therapeutic professions. Subgroup analyses investigated the role of gender and age regarding technical affinity. Measures included custom-made attitudinal statements towards teletherapy and the standardized TA-EG survey.
Results
The COVID-19 lockdown caused attitude changes towards teletherapy – for example, in terms of interest (r = 0.57, p > 0.01), perceived skills for performance of teletherapy (r = 0.33, p > 0.01) and perceived need for physical contact with patients (r = 0.35, p > 0.01). Regarding technical affinity, women reported significantly higher values than men did (r = 0.32, p > 0.01). Nearly half of the participants already applied teletherapy, with mainly positive ratings regarding perceived skills and feasibility. Barriers identified were missing or unstable reimbursement policies by insurance companies and therapeutic software with guaranteed data security.
Discussion
Austrian therapists indicate a relatively high level of telehealth positivity, with an improvement in the course of the COVID-19 lockdown. However, therapists outline the need for stable reimbursement policies and secure software solutions.
Teledermatology has become critical for maintaining patient access to dermatologic services since the eruption of the COVID-19 pandemic. This survey of first-time synchronous teledermatology patients (n = 100) seen by providers of the University of Mississippi Medical Center during Spring 2020 was designed to learn more about patient experiences associated with the technical challenges of synchronous teledermatology. Our patient population had considerable experience with various social media including Facebook (82%) and hardware platforms, such as Apple devices (66%). We found that the majority of patients were satisfied (88.9%) with their synchronous teledermatology encounter and 81.8% of patients did not experience a technical difficulty with their consult. About 15% of patients lost connection with their provider during their consultation. Furthermore, about 30% of patients rated “showing their skin” to their provider as “hardest” on a ten scale. However, about 34% of patients sent “store-and-forward”-type images to supplement their encounter. Despite overwhelming satisfaction with synchronous teledermatology, a majority prefer an in-person consultation for their next visit (68.7%). Synchronous teledermatology offers a critical service to patients to expand access to specialty consultation. It is well-received by patients despite technical barriers, especially during a global health crisis.
Background
Although telehealth is considered a key component in combating the worldwide crisis caused by COVID-19, the factors that influence its acceptance by the general population after the flattening of the COVID-19 curve remain unclear.
Objective
We aimed to identify factors affecting telehealth acceptance, including anxiety related to COVID-19, after the initial rapid spread of the disease in South Korea.
Methods
We proposed an extended technology acceptance model (TAM) and performed a cross-sectional survey of individuals aged ≥30 years. In total, 471 usable responses were collected. Confirmatory factor analysis was used to examine the validity of measurements, and the partial least squares (PLS) method was used to investigate factors influencing telehealth acceptance and the impacts of COVID-19.
Results
PLS analysis showed that increased accessibility, enhanced care, and ease of telehealth use had positive effects on its perceived usefulness (P=.002, P<.001, and P<.001, respectively). Furthermore, perceived usefulness, ease, and privacy/discomfort significantly impacted the acceptance of telehealth (P<.001, P<.001, and P<.001, respectively). However, anxiety toward COVID-19 was not associated with telehealth acceptance (P=.112), and this insignificant relationship was consistent in the cluster (n=216, 46%) of respondents with chronic diseases (P=.185).
Conclusions
Increased accessibility, enhanced care, usefulness, ease of use, and privacy/discomfort are decisive variables affecting telehealth acceptance in the Korean general population, whereas anxiety about COVID-19 is not. This study may lead to a tailored promotion of telehealth after the pandemic subsides.
The COVID-19 pandemic has led to a crisis in the provision of usual services, including face-to-face (FTF) outpatient clinics. The need for change came abruptly in late March 2020 as routine clinics were cancelled. We accelerated the delivery of our teleclinics (telephone and video) in rheumatology, which we had started doing prior to the pandemic. 396 patients were reviewed during the lockdown by teleclinics. 39 (10%) of patients were discharged, 102 (26%) had treatment adjusted without bringing forward their appointment, 39 (10%) had tests ordered and prescriptions issued, 160 (40%) were reviewed and booked for a future appointment, thus reducing the current waiting list, and 22 (6%) were placed a patient-initiated follow-up plan. Only 10 (3%) required a conversion from the teleclinic to a FTF clinic in the near future. The COVID-19 crisis offered us the opportunity to do things we had been considering for some time. Our aim is now to continue with this new way of working as we move to the recovery phase and beyond. We would suggest that adoption of these changes in other trusts could significantly improve the quality of the care for patients not only in rheumatology but also throughout the NHS.
Telepractice facilitates services in exceptional settings and situations. The ongoing COVID-19 pandemic is certainly such a situation. Due to pandemic-related restrictions, speech-language pathologists (SLPs) needed to adopt new approaches to their professional functioning. The aim of the paper is to examine SLP professionals’ perceptions and application of telepractice in SLP settings in Croatia during the COVID-19 pandemic. Two hundred and fifty-five SLPs completed an online survey. The results demonstrated that most SLPs had provided direct online therapy, mainly those employed in health care and private practice. The chief reasons for clients’ refusal of therapy delivered via telepractice included the lack of equipment, insufficient independence, and doubts on the effectiveness of telepractice. Although only 3% of SLPs had acquired some formal knowledge of telepractice before the pandemic, over 70% expressed satisfaction with telepractice because it allowed them to provide undisturbed clinical services in an exceptional situation.
Healthcare information technologies (HIT) can address several challenges faced by healthcare systems. To benefit from the advantages HIT offer, users must first accept them. This meta-analysis synthesizes previous research on HIT acceptance. It uses data from 214 independent samples reported in 193 articles and 83,619 technology users from 33 countries. The study contributes to the HIT literature by (1) synthesizing the empirical findings on technology acceptance factors and combining them in a comprehensive model, (2) testing the mediating mechanisms of health technology acceptance, and (3) examining contextual differences. The study finds that HIT acceptance depends on various predictors proposed by the technology acceptance model and the unified theory of acceptance and use of technology. These factors displayed strong indirect effects through effort expectancy, perceptions of the technology, performance expectancy, and attitudes toward using HIT. Studies overlooking these effects may underestimate the importance of various acceptance factors. Finally, the results suggest that technology acceptance varies across healthcare technologies (remote information systems [IS], wearables), users (staff/patients, age, voluntariness, experience), and locations (hospitals, healthcare systems, life expectancy in country). We also provide IS managers with guidance for improving technology acceptance in the healthcare industry to ensure efficient, high-quality services.
The global COVID‐19 pandemic has fundamentally changed the way we live and work in the short‐term, but history suggests that the crisis may also exert deeper, longer‐lasting effects. With the aim of providing preliminary insight into this possibility, we theoretically construct and empirically test hypotheses for how exposure to COVID‐19 stimuli (e.g., reading or watching media coverage, observing relief efforts) relates to the deep‐seated values that guide workers' attitudes and behaviors. Specifically, we build from prior work to posit that exposure to COVID‐19 stimuli is positively associated with workers' self‐transcendent prosocial values, which motivate prosocial behaviors directed toward society as a whole (i.e., charitable donations) and coworkers (i.e., helping). Extend the extant literature, we further argue that exposure to COVID‐19 stimuli will be positively associated with conservation values emphasizing self‐restraint, submission, protection of order, and harmony in relations, which in turn influences workers' willingness to tolerate mistreatment by authorities (i.e., abusive supervision, authoritarian leadership, exploitation). Evidence from 2,929 full‐time Chinese employees tracked for nearly 2 months and a diverse sample of 310 workers in the United States generally support our arguments, but also provide insight into potential cultural nuances.
Objectives: In recent years, telemedicine has emerged in China to help address problems concerning access to and the cost of medical treatment. The aim of this study was to explore the factors influencing residents’ adoption of telemedicine services. Methods: Using social cognitive theory, we analyzed individual and environmental factors that influence patients’ behavioral intentions with respect to telemedicine. We distributed questionnaires to patients who had used telemedicine in Dongtai, and 279 valid samples were collected. Results: The reliability and validity were acceptable. Eight of the 9 hypotheses were supported at the 0.05 significance level. Motivation had positive correlations with self-efficacy and trust, self-rated health was positively correlated with trust, subjective norms were positively correlated with self-efficacy and trust, institution size was positively correlated with trust, and self-efficacy and trust were positively correlated with patients’ intentions to use telemedicine. Conclusions: Motivation and subjective norms can promote behavioral intentions by promoting self-efficacy and trust, and self-rated health and institution size can promote behavioral intentions by promoting trust. These findings explain the antecedents of patients’ behavioral intentions to use telemedicine and support specific policy recommendations for the development of telemedicine services.
Background:
Due to the COVID-19 pandemic, telephone clinics have been utilised to reduce the risk of transmission. Evidence supporting its quality and safety is required.
Aims:
Assess the efficacy and safety of telephone clinics in delivering care to established oncology patients and assess patient and health professionals' preference (telephone vs face-to-face clinics).
Methods:
Retrospective chart audit in the month preceding and month following introduction of telephone clinics at the Gold Coast University hospital and a patient and health professional questionnaire.
Results:
In total, 1212 clinical encounters occurred in the month post the introduction of telephone clinics (vs 1208 encounters prior). There were no statistically significant differences in 24-h (18 vs 22, p = 0.531) or 7-day admissions (50 vs 46, p = 0.665) comparing encounters in the month prior to the introduction of telephone clinics vs the month post, but there was a statistically significant difference in 30-day mortality post systemic therapy in favour of the post-telephone clinic period (7 vs 0 patients, p = 0.008). Of the 222 patients who undertook the questionnaire, 42.3% preferred telephone clinics (95% CI 35.97-48.97), 25.2% preferred face-to-face clinics (95% CI 19.92-31.39) and 32.4% did not prefer one method over another. Of the 24 health professionals who undertook the questionnaire, 70.8% felt patients preferred phone clinics.
Conclusions:
Generally, patients and clinicians viewed telephone clinics favourably. Nevertheless, a large portion of patients still prefer face-to-face clinics. Services should be tailored to individual preferences. Although there were no 'red flags' in terms of mortality or admission rates, further longitudinal research is required. This article is protected by copyright. All rights reserved.
Introduction
Internationally the COVID-19 pandemic has triggered a dramatic and unprecedented shift in telehealth uptake as a means of protecting healthcare consumers and providers through remote consultation modes. Early in the pandemic, Australia implemented a comprehensive and responsive set of policy measures to support telehealth. Initially targeted at protecting vulnerable individuals, including health professionals, this rapidly expanded to a “whole population” approach as the pandemic evolved. This policy response supported health system capacity and community confidence by protecting patients and healthcare providers; creating opportunities for controlled triage, remote assessment and treatment of mild COVID-19 cases; redeploying quarantined or isolated health care workers (HCWs); and maintaining routine and non-COVID healthcare.
Purpose
This paper provides a review of the literature regarding telephone and video consulting, outlines the pre-COVID background to telehealth implementation in Australia, and describes the national telehealth policy measures instituted in response to COVID-19. Aligned with the existing payment system for out of hospital care, and funded by the national health insurance scheme, a suite of approximately 300 temporary telehealth Medicare-subsidised services were introduced. Response to these initiatives was swift and strong, with 30.01 million services, at a cost of AUD $1.54 billion, claimed in the first six months.
Findings
This initiative has been a major policy success, ensuring the safety of healthcare consumers and healthcare workers during a time of great uncertainty, and addressing known financial risks and barriers for health service providers. The risks posed by COVID-19 have radically altered the value proposition of telehealth for patients and clinicians, overcoming many previously encountered barriers to implementation, including willingness of clinicians to adopt telehealth, consumer awareness and demand, and the necessity of learning new ways of conducting safe consultations. However, ensuring the quality of telehealth services is a key ongoing concern.
Conclusions
Despite a preference by policymakers for video consultation, the majority of telehealth consults in Australia were conducted by telephone. The pronounced dominance of telephone item numbers in early utilisation data suggests there are still barriers to video-consultations, and a number of challenges remain before the well-described benefits of telehealth can be fully realised from this policy and investment. Ongoing exposure to a range of clinical, legislative, insurance, educational, regulatory, and interoperability concerns and solutions, driven by necessity, may drive changes in expectations about what is desirable and feasible – among both patients and clinicians.
Low barrier addiction clinics increase access to medications to treat substance use disorders, while emphasizing harm reduction. The Harm Reduction and BRidges to Care (HRBR) Clinic is an on demand, low barrier addiction clinic that opened in October 2019. In the first three months of operation (November through January , 2020), HRBR saw steadily increasing numbers of patients.
Oregon saw its first case of novel coronavirus in February, and declared a state of emergency and enacted a formal “Stay at Home” order in March. That same month, the DEA announced that patients could be initiated on buprenorphine through telemedicine visits without an in-person exam. Within a week of being granted the ability to see patients virtually, HRBR had transitioned to over 90% virtual visits, while still allowing patients without technology to access in-person care. Within four weeks, the clinic expanded hours significantly, established workflows with community harm reduction partners, and was caring for patients in rural areas of the state.
In response to the COVID-19 crisis, the HRBR clinic was able to quickly transition from in-person to almost completely virtual visits within a week. This rapid pivot to telemedicine significantly increased access to care for individuals seeking low-threshold treatment in multiple contexts. Overarching institutional support, grant funding and a small flexible team were critical. HRBR's increased access and capacity were only possible with the Drug Enforcement Agency loosening restrictions around the use of telehealth for new patients. Keeping these altered regulations in place will be key to improving health and health care equity for people who use drugs, even after the pandemic subsides. Further research is needed in to whether addiction telemedicine impacts medication diversion rates, continued substance use, or provider practices.
Background
Cystic Fibrosis (CF) is a chronic multi-system disease best cared for at Care centers with routine monitoring by interdisciplinary teams. Previously, remote home monitoring technology has been explored to augment in-person care. During the COVID-19 pandemic, traditional in-person care was limited and CF centers rapidly adapted to a telehealth delivery model. The purpose of this study was to understand how people with CF (PwCF) and families of PwCF experienced the shift to telehealthcare delivery.
Methods
This was a cross-sectional survey-based study conducted in 11 CF Centers. Two surveys were designed (one for adult PwCF and one for parents/guardians of PwCF) by participating CF center members with patient and family partner input. Surveys were disseminated electronically via email/text to all patients who completed a telehealth visit, and data were collected on secure Google Forms.
Results
Respondents rated their telehealth experiences as positive. Most were highly satisfied with their telehealth visit (77% adult, 72% pediatric) and found the visits to be highly convenient (85% for all surveyed). A majority of patients reported they had adequate time during the visit and had all questions and concerns addressed. Importantly, we also identified concerns regarding lack of in-person assessments including pulmonary function testing (PFT) and throat/sputum culture.
Conclusion
Telehealth was a feasible and well-accepted mechanism for delivering care in a chronic CF care model during the COVID-19 pandemic and may be useful in the post-pandemic era. Further work is needed to understand the impact of telehealth on patient outcomes, healthcare utilization and associated cost.
COVID‐19 has presented significant challenges for public healthcare systems across the globe. The critical challenge for public healthcare organisations is to provide effective health care to patients, while simultaneously keeping frontline staff safe. Telemedicine has emerged as a prominent service intervention to this end. Telemedicine integrates technologies into medical practices to alleviate the need for face‐to‐face interactions through video consultations. The study explores how physicians and patients can, together, co‐create service value both within the telemedicine ecosystem and under crisis. Secondary qualitative data from physicians and patients active on Twitter and from across multiple countries are used to this end. Thematic analysis reveals seven themes that inform a new integrative telemedicine value co‐creation framework, which provides a platform for inclusive, equitable, and sustainable telemedicine services. The study provides a new understanding of the service triad ‒ telemedicine co‐design, value co‐creation, and service improvement ‒ highlighting the roles of co‐design and value co‐creation for public health care under crises.
The coronavirus disease 2019 SARS-CoV-2 (COVID-19) crisis and subsequent social distancing recommendations resulted in increased use of telehealth within recovery-oriented behavior health services (RS). Populations with serious mental illness (SMI) rely on psychosocial treatment, care coordination, and pharmacotherapy to achieve recovery goals and increase community engagement. This program evaluation of a group-based RS used mixed methods to better understand the multiple factors that contributed to successful telehealth conversion. Clients’ service utilization over an 18-week period was collected to determine acceptance and the client characteristics associated with utilization (n = 72). Clients completed a treatment satisfaction questionnaire that was distributed ten weeks following telehealth conversion. Qualitative interviews explored staff perspectives on factors that impacted conversion, acceptance, and utilization. Initial staff skepticism gave way to acceptance, while the demands of resourcefulness, flexibility, and competency were emphasized. Clients’ treatment utilization remained stable, while the number of missed/cancelled sessions were less frequent over time, especially for clients with a history of psychosis. Clients reported high overall satisfaction, but a preference for in-person treatment. Within this clinic serving middle to high socioeconomic status (SES) clients, clinicians and clients alike found the virtual group-based RS to be feasible and acceptable while in-person treatment was not an option.
Social care services are commonly delivered by a combination of for-profit, public, and non-profit sector providers. These services are often commissioned in quasi-markets, in which providers from all sectors compete for public service contracts. The outsourcing of social services to private providers has resulted in a predominantly for-profit provision. Despite the rationale that open bidding facilitates better services and improved consumer choice, the outsourcing of social care has been criticized for relying on principles of New Public Management, which are often viewed as prioritising cost-efficiency above service quality and effectiveness. However, the experiences and perspectives of those operating within quasi-markets (providers and commissioners) are poorly understood. To address this gap, we systematically identified, appraised, and thematically synthesised existing qualitative research on social care commissioners and providers (for-profit, public, and non-profit) published in the last 20 years (2000-2020). Twenty-six studies examining the perspectives of social care providers and commissioners relating to the quasi-market provision of social care were included. The synthesis demonstrates consistent concern among non-profit and public providers with regard to spending cuts in the care sector, which was not present in the studies of for-profit providers, where there was more concern with creating a profitable market strategy by carefully analysing opportunities in the commissioning system. All provider types described flaws in the commissioning process, especially with regards to the contracting conditions, which were reported to force providers into deteriorating employment conditions, and also to negatively impact quality of care. These findings suggest that in a commissioning environment characterised by austerity and public budget cuts, it is insufficient to assume that increasing the market share of non-profits will alleviate issues grounded in insufficient funding and flawed contracting criteria. In other words, no ownership type can compensate for inadequate funding of social care services.
How do crises shape digital innovation? In this paper we examine the rapid adoption of digital telemedicine technologies in an Israeli hospital with a focus on the role of the institutional logics held by the stakeholders responding to emerging events. With the onset of COVID-19, the need for social distancing and minimal physical contact challenged and interrupted hospital practices. In response, remote audiovisual functionality of digital technologies were appropriated in different ways, as stakeholders-state actors, managers, health professionals, and family members-sought to improvise and enhance the protection of persons concerned. We show how emerging practices were guided by the dominant institutional logics of stakeholders responding to the crisis. Acting for many as a digital form of 'personal protective equipment' (PPE), the technologies enabled diverse action possibilities to become manifest in practices. We add to understanding the role of institutional logics in directing the attention of stakeholders to shape digital innovation in times of crisis.
Much recent scholarly investigation has been focused on the promise of digitalization and the new ways of working and organizing it makes possible. In this paper, we analyze how the COVID-19 pandemic has acted as a natural breaching experiment that has challenged taken-for-granted expectations about digitalization and revealed four important issues: uneven access to digital infrastructures, the persistence of the analog in digitalization, the brittleness of unchecked digitalization, and panoptical surveillance. The sudden shift to digital work has exposed taken-for-granted assumptions about the universality of digital access. The crisis has also revealed that many highly digitalized processes still rely on analog elements. The pandemic has also exposed that many algorithms used in digitalized inter-organizational processes are brittle due to overreliance on historic patterns. Finally, the pandemic has breached fundamental expectations of privacy when organizational surveillance was extended into private and public spaces. Thus, the pandemic has laid bare fundamental challenges in digitalization and has exposed the limits of rose‑tinted thinking about the relation between technology and organizing.
Purpose
Telemedicine use in otolaryngology waxed and waned during the COVID-19 pandemic outbreak in the U.S. Assessing the patterns of telemedicine use and its perceived limitations during the COVID-19 outbreak in 2020 allows identification and correction of impediments to consistent telemedicine use by otolaryngologists.
Materials and methods
Full-time faculty of 2 academic otolaryngology departments in New York City were surveyed regarding their telemedicine use from March through August 2020 during the “first wave” of the COVID-19 pandemic. Based on these findings, a method of “augmented outpatient otolaryngology teleconsultation” designed to enhance the quality of the physical examination was developed and employed from August to December 2020. Patients receiving this augmented teleconsult were anonymously surveyed about their telemedical experience.
Results
Telemedicine use by faculty was minimal prior to the pandemic, but as total outpatient volume decreased 65–84% across subspecialties, it was used by all otolaryngologists during COVID-19. Physicians were less confident in making a telemedical diagnosis at all phases of the study in all subspecialties. Patients who had an augmented otolaryngology teleconsultation were satisfied with it, believed it facilitated earlier care, limited the time and cost of travel to the physician's office and felt their physician was able to perform a sufficient physical examination.
Conclusions
During the COVID-19 crisis, physicians utilized teleotolaryngology to provide care but were less satisfied with their ability to make an accurate diagnosis. Inexpensive direct-to-consumer digital otoscopes can improve the quality of the physical examination provided and can address both patient and physician needs.
Background
Telehealth services have helped enable continuity of care during the coronavirus pandemic. We aimed to investigate use and views towards telehealth among allied health clinicians treating people with musculoskeletal conditions during the pandemic.
Methods
Cross-sectional international survey of allied health clinicians who used telehealth to manage musculoskeletal conditions during the coronavirus pandemic. Questions covered demographics, clinician-related factors (e.g. profession, clinical experience and setting), telehealth use (e.g. proportion of caseload, treatments used), attitudes towards telehealth (Likert scale), and perceived barriers and enablers (open questions). Data were presented descriptively, and an inductive qualitative thematic content analysis approach was used for qualitative data, based on the Capability-Opportunity-Motivation Behavioural Model.
Results
827 clinicians participated, mostly physiotherapists (82%) working in Australia (70%). Most (71%, 587/827) reported reduced revenue (mean (SD) 62% (24.7%)) since the pandemic commenced. Median proportion of people seen via telehealth increased from 0% pre (IQR 0 to 1) to 60% during the pandemic (IQR 10 to 100). Most clinicians reported managing common musculoskeletal conditions via telehealth. Less than half (42%) of clinicians surveyed believed telehealth was as effective as face-to-face care. A quarter or less believed patients value telehealth to the same extent (25%), or that they have sufficient telehealth training (21%). Lack of physical contact when working through telehealth was perceived to hamper accurate and effective diagnosis and management.
Conclusion
Although telehealth was adopted by allied health clinicians during the coronavirus pandemic, we identified barriers that may limit continued telehealth use among allied health clinicians beyond the current pandemic.
Purpose
This paper aims to explore how hospitable telemedicine services empowered patients during the COVID-19. Expanding from the technology aspect, this research integrated the philosophy of hospitality organizational culture by including factors related to human-human interaction as significant predictors for patients’ sense of empowerment (perceived competence and control) in coping with their emotional stress (anxiety and isolation).
Design/methodology/approach
Survey data were obtained from 409 general consumers who have used video-based virtual consultation since February 2020. Stepwise multiple regression and simple linear regression analyses were used for hypotheses testing.
Findings
The results reveal that the doctors’ reliability, responsiveness and empathy significantly predict patients’ perceived competence and control. Perceived usefulness and convenience of telemedicine technology enhance patients’ perceived competence and control. Patients’ sense of empowerment significantly reduces their anxiety and sense of isolation.
Research limitations/implications
To fully understand the role of hospitality in people’s telemedicine experiences, future studies are encouraged to not only examine the patients-clinicians interactions but also explore the patients-support staff interactions.
Practical implications
Health-care service providers’ “bed-side” manners empower patients in managing their emotional stress. Health-care service providers should be trained for their empathetic ability and communication skills. Strategies such as collaborating with hospitality schools and business schools can be implemented to help build medical student’s patient-centric attitudes and skills.
Originality/value
This paper provided empirical evidence for the value of hospitality in health care and offered useful suggestions for health care providers, especially by empowering vulnerable people during catastrophic events such as COVID-19.
The current health care crisis and need for social distancing to protect medical practitioners and patients has necessitated the need to adopt new initiatives for treatment of patients. One of such initiatives is the adoption of telemedicine which involves diagnosis or medical service provided by a consulting physician to patients digitally. Telemedicine is implemented using telecommunication technology either asynchronously or synchronously via audio and video systems. Therefore, this study adopts an integrative literature review to provide evidence on the role of telemedicine to support digital health care for management of Coronavirus disease 2019 (COVID-19) pandemic. Findings from this study presents the benefits of integrating telemedicine for digital health care management. Additionally, findings discuss how telemedicine can be integrated for remote management of health care. Besides, recent polices and trends in telemedicine are discussed. Implications from this study discuss the challenges and recommendations on how telemedicine can be integrated for digital health care management during the COVID-19 pandemic. This study provides a timely guide on the potential of telemedicine to support digital health care as a response to COVID-19 crises now and into the future.
Background:
An analysis of data from an international survey was undertaken to determine the impact of the COVID-19 pandemic on telehealth practice in occupational therapy worldwide, in addition to facilitators and barriers in utilising this form of service delivery.
Method:
The global online survey was circulated in the occupational therapy community by the World Federation of Occupational Therapists (WFOT) between April and July 2020, collecting responses to closed-ended questions, in addition to free-text comments. Descriptive statistics and bivariate analyses were used to assess relationships between respondent characteristics and the utilisation of telehealth. Thematic statement analysis provided further insight regarding factors impacting telehealth use.
Results:
Findings revealed a significant increase in the use of telehealth strategies with the onset of the pandemic among survey respondents, with many reported benefits. Bivariate analyses indicated telehealth users were more likely to score higher feelings of safety and positive work morale, as well as perceive employer expectations to be reasonable. Restricted access to technology, limitations of remote practice, funding issues and slow pace of change were identified as barriers for some respondents for use of telehealth. Facilitators included availability of supportive policy, guidelines and strategies, in addition to education and training.
Conclusion:
This study advances the understanding of the current scope of occupational therapy telehealth practice in the context of the ongoing COVID-19 pandemic. Although results suggest long-term potential for telehealth use as an adjunct to traditional service provision, important considerations were identified regarding factors influencing integration of such strategies.
Study design:
Retrospective questionnaire study of all patients seen via telemedicine during the COVID-19 pandemic at a large academic institution.
Objective:
This aim of this study was to compare patient satisfaction of telemedicine clinic to in-person visits; to evaluate the preference for telemedicine to in-person visits; to assess patients' willingness to proceed with major surgery and/or a minor procedure based on a telemedicine visit alone.
Summary of background data:
One study showed promising utility of mobile health applications for spine patients. No studies have investigated telemedicine in the evaluation and management of spine patients.
Methods:
An 11-part questionnaire was developed to assess the attitudes toward telemedicine for all patients seen within a 7-week period during the COVID-19 crisis. Patients were called by phone to participate in the survey. χ2 and the Wilcoxon Rank-Sum Test were performed to determine significance.
Results:
Ninety-five percent were "satisfied" or "very satisfied" with their telemedicine visit, with 62% stating it was "the same" or "better" than previous in-person appointments. Patients saved a median of 105 minutes by using telemedicine compared to in-person visits. Fifty-two percent of patients have to take off work for in-person visits, compared to 7% for telemedicine. Thirty-seven percent preferred telemedicine to in-person visits. Patients who preferred telemedicine had significantly longer patient-reported in-person visit times (score mean of 171) compared to patients who preferred in-person visits (score mean of 137, P = 0.0007). Thirty-seven percent of patients would proceed with surgery and 73% would proceed with a minor procedure based on a telemedicine visit alone.
Conclusion:
Telemedicine can increase access to specialty care for patients with prolonged travel time to in-person visits and decrease the socioeconomic burden for both patients and hospital systems. The high satisfaction with telemedicine and willingness to proceed with surgery suggest that remote visits may be useful for both routine management and initial surgical evaluation for spine surgery candidates.Level of Evidence: 3.
Virtual encounters have experienced an exponential rise amid the current COVID-19 crisis. This abrupt change, seen in response to unprecedented medical and environmental challenges, has been forced upon the orthopaedic community. However, such changes to adopting virtual care and technology were already in the evolution forecast, albeit in an unpredictable timetable impeded by regulatory and financial barriers. This adoption is not meant to replace, but rather augment established, traditional models of care while ensuring patient/provider safety, especially during the pandemic. While our department, like those of other institutions, has performed virtual care for several years, it represented a small fraction of daily care. The pandemic required an accelerated and comprehensive approach to the new reality. Contemporary literature has already shown equivalent safety and patient satisfaction, as well as superior efficiency and reduced expenses with musculoskeletal virtual care (MSKVC) versus traditional models. Nevertheless, current literature detailing operational models of MSKVC is scarce. The current review describes our pre-pandemic MSKVC model and the shift to a MSKVC pandemic workflow that enumerates the conceptual workflow organization (patient triage, from timely care provision based on symptom acuity/severity to a continuum that includes future follow-up). Furthermore, specific setup requirements (both resource/personnel requirements such as hardware, software, and network connectivity requirements, and patient/provider characteristics respectively), and professional expectations are outlined. MSKVC has already become a pivotal element of musculoskeletal care, due to COVID-19, and these changes are confidently here to stay. Readiness to adapt and evolve will be required of individual musculoskeletal clinical teams as well as organizations, as established paradigms evolve.
Cite this article: Bone Joint Open 2020;1-6:272–280.