Research Articles and Papers
Browse our library of telehealth research studies.
Older Veterans' Experiences of a Multicomponent Telehealth Program: Qualitative Program Evaluation Study
This study focuses on addressing the multifaceted needs of older veterans with multiple health conditions through a telehealth program. Qualitative interviews with program participants identified areas for improvement and adaptation.
This cohort study investigated the telehealth use in skilled nursing facilities (SNFs) during the COVID-19 pandemic. The study revealed that telehealth adoption in SNFs significantly increased in early 2020 and gradually stabilized at a higher rate than before the pandemic. Importantly, higher telemedicine use in SNFs was linked to improved access to psychiatry visits.
This study examines trends in mental health service utilization and spending before and during the COVID-19 pandemic. During the acute phase of the pandemic, in-person visits decreased and telehealth visits increased. In the post-acute phase, telehealth visits stabilized and in-person visits increased, resulting in overall mental health service utilization being higher than before the pandemic by August 2022.
This study investigated telehealth disparities among prostate cancer survivors. One-third of survivors had used telehealth, with 10% considering it comparable to in-person visits. Those with lower education were less likely to use telehealth and less likely to feel inclined to use it, highlighting the importance of addressing these disparities.
Telemedicine in Primary Care: Lessons Learned About Implementing Health Care Innovations During the COVID-19 Pandemic
This research study examines the experiences of primary care clinicians with telemedicine during the first two years of the COVID-19 pandemic. Respondents noted initial telehealth implementation challenges due to infrastructure and reimbursement issues. Over time, clinicians' attitudes toward telemedicine improved, with many considering it an important tool alongside in-person care.
Why U.S. Patients Declined Hospital-at-Home during the COVID-19 Public Health Emergency: An Exploratory Mixed Methods Study
This study aimed to understand patient refusals of hospital-at-home during the COVID-19 Public Health Emergency. The study highlights the need to improve education about hospital-at-home and to address domestic barriers and diagnostic challenges.
Use of Medication for Opioid Use Disorder Among Adults With Past-Year Opioid Use Disorder in the US, 2021
This study examines the prevalence of medication for opioid use disorder (MOUD) receipt among US adults with past-year opioid use disorder (OUD). The study found that despite guidelines recommending MOUD, around 1 in 5 adults with past-year OUD received any form of MOUD. Disparities were identified, particularly among Black adults, women, the unemployed, and those in nonmetropolitan areas, who were less likely to receive MOUD. Those who used telehealth for substance use treatment were more likely to have received MOUD.
Towards a conceptual framework for addressing state-level barriers to decentralized clinical trials in the U.S.
This article proposes a framework to identify barriers to decentralized clinical trials, including those related to policies and regulations governing virtual care.
Telehealth Lifestyle Redesign Occupational Therapy for Diabetes: Preliminary Effectiveness, Satisfaction, and Engagement
This research evaluates telehealth delivery in an occupational therapy intervention for young adults with diabetes. Preliminary results suggest that telehealth clients experienced significant improvements in occupational performance, satisfaction, and health management, with high levels of satisfaction.
The research demonstrates that telehealth is effective for pediatric occupational therapy and that remote parent coaching provides benefits for parents and infants. The study evaluated telehealth-delivered observational autism screening tool for infants, with parents achieving an 82% adherence rate to the fidelity checklist. This study suggests that a parent coaching telehealth approach may be valid for pediatric telehealth assessments.
Federal telehealth policy changes during the COVID-19 public health emergency: Associations with telemental health use among rural and urban Medicare beneficiaries
Medicare beneficiaries faced increased mental health concerns with limited access to mental health services during the COVID-19 pandemic. This study compared rural and urban Medicare fee-for-service beneficiary use of telemental health from 2019 to 2020. The analysis found a significant rise in telemental health use for both groups, with urban residents benefiting disproportionately. Among rural beneficiaries, older age was linked to lower telemental health use, indicating a need to address barriers.
Rural-Urban Disparities in Video Telehealth Use During Rapid Mental Health Care Virtualization Among American Indian/Alaska Native Veterans
This research focuses on the differences in utilization of video telehealth for mental health care among American Indian/Alaska Native veterans and non-American Indian/Alaska Native veterans. The study reveals increased telehealth use across all veteran groups but noted a significant difference in telehealth use among rural and urban populations, especially among American Indian/Alaska Native veterans.
This study aimed to explore the prevalence and perceptions of telehealth services among occupational therapy practitioners (OTPs) in oncology. The findings indicate that despite limited access prior to the COVID-19 pandemic, a majority of OTPs in oncology settings support telehealth use, with the highest endorsement relating to accessibility. Telehealth-delivered occupational therapy treatments in oncology were considered well-suited for areas such as education, quality of life, and psychosocial interventions.
The article examines the impact of the COVID-19 pandemic on advanced practice registered nurses (APRNs) and their use of telehealth. While a majority of APRNs did not utilize telehealth before the pandemic, its use significantly increased during the pandemic, with half of the respondents incorporating telehealth into their daily practice. The findings highlight both the barriers faced, such as limited access to technology for certain populations, and the benefits observed, including improved patient access to care. The study emphasizes the need for enhanced APRN education, policy, and practice to ensure expanded health care access.
Updated Medicare FFS Telehealth Trends by Beneficiary Characteristics, Visit Specialty, and State, 2019-2021
This research examines Medicare fee-for-service (FFS) use of telehealth from 2019 to 2021 by beneficiary characteristic, visit specialty, and geography. This report found telehealth use among Medicare FFS beneficiaries in 2021 continued to be far above pre-pandemic levels, but lower than at the peak of 2020. Telehealth use in 2021 remained highest for behavioral health compared to non-behavioral health among Medicare FFS beneficiaries. The analysis found audio-only eligible telehealth comprised about one quarter of Medicare FFS telehealth in both 2020 and 2021. This report notes a wide variation across states in use of telehealth for Medicare FFS beneficiaries.
Expansion of Telehealth Availability for Mental Health Care After State-Level Policy Changes From 2019 to 2022
This cohort study examined the association between state policies and telehealth availability at outpatient mental health treatment facilities. The study found that the implementation of four state policies, including payment parity for telehealth services, authorization of audio-only telehealth services for Medicaid and Children's Health Insurance Program (CHIP) beneficiaries, participation in the Interstate Medical Licensure Compact (IMLC), and participation in the Psychology Interjurisdictional Compact (PSYPACT), were associated with increased odds of telehealth availability. However, telehealth services were less likely to be offered in counties with a higher proportion of Black residents and in facilities that accepted Medicaid and CHIP.
Expansion of Telehealth Availability for Mental Health Care After State-Level Policy Changes From 2019 to 2022
This study aimed to investigate the associations between state policies and the availability of telehealth services at outpatient mental health treatment facilities. The state policies studied, payment parity, reimbursement for audio-only, participation in the Interstate Medical Licensure Compact, and participation in the Psychology Interjurisdictional Compact, were associated with expansion of telehealth availability for mental health care at mental health treatment facilities.
The use of telehealth-supported stewardship activities in acute-care and long-term care settings: An implementation effectiveness trial
This study assessed the implementation of telehealth-supported stewardship activities in Veterans' Administration medical centers acute-care and long-term care units. The program resulted in reductions in antibiotic use in long-term care units but not in smaller acute-care units.
Primary Care Telemedicine Use among Assisted Living Residents with Dementia during COVID-19: Race and Dual Enrollment Status
Telehealth services expanded to help primary care providers connect to assisted living facility residents with dementia during the COVID-19 pandemic. This study found that while Black and Hispanic assisted living facility residents and those in assisted living facilities with a higher proportion of duals were less likely to use telehealth early in the pandemic these racial and ethnic or socioeconomic differences did not persist.
Care coordination between rural primary care and telemedicine to expand medication treatment for opioid use disorder: Results from a single-arm, multisite feasibility study
This study focuses on the feasibility of implementing a care coordination model involving telemedicine for medication treatment of opioid use disorder (MOUD) in rural settings. The intervention involved establishing referral and coordination between rural clinics and a telemedicine provider. Results indicated that implementing the care coordination model led to an increase in patient-days on MOUD, particularly in clinics with limited MOUD capacity. This suggests that the model is most effective in expanding access to MOUD in rural areas where resources for MOUD are limited.
Telemental health in emergency care settings: A qualitative analysis of considerations for sustainability and spread
The study examines the barriers and facilitators for the sustainability and expansion of a model of telehealth care, telemental health video. The findings showed overall satisfaction, with increased comfort for patients in discussing difficult topics, and benefits for clinicians in terms of cross-coverage and safety. Adequate infrastructure and workforce capacity are crucial to ensure successful uptake of this model.
Telehealth for management of chronic non-cancer pain and opioid use disorder in safety net primary care
This study qualitatively assesses the benefits and challenges of telehealth for managing chronic non-cancer pain, opioid use disorder, and multi-morbidity in urban safety net primary care patients. Factors such as patient burden, communication and technology challenges, pain control, opioid misuse, and medical complexity should be considered when making decisions about continuing or expanding telehealth services.
This study analyzed trends in prenatal telehealth visits during pregnancy and identified patient characteristics associated with the number of prenatal telehealth visits. The findings showed prenatal telehealth utilization increased significantly during the COVID-19 pandemic.
Association between broadband capacity and telehealth utilization among Medicare Fee-for-service beneficiaries during the COVID-19 pandemic
This study used county-level data to assess the association between broadband access and telehealth utilization in the United States during the COVID-19 pandemic. The findings show decreased telehealth utilization in rural areas and indicates the importance of broadband access for health care access.
This study examines how Whole Health coaches adapted to using telehealth to engage rural Veterans during the COVID-19 pandemic, identifying advantages and gaps. Findings emphasize the need for a blended approach that integrates virtual, in-person, and lower-tech options.
Implementation of a women's reproductive behavioral health telemedicine program: a qualitative study of barriers and facilitators in obstetric and pediatric clinics
This study focuses on the implementation of a telemedicine program for perinatal mood and anxiety disorders and substance use disorders in community obstetric and pediatric clinics. Barriers to implementation included practical challenges such as staffing, space, and technology support, while facilitators included the high demand for mental health and substance use disorder services and the commitment of clinics to address these health concerns. The study highlights the importance of addressing resource and technology needs, while leveraging clinics' commitment to women's health, to ensure successful implementation of telemedicine programs.
Association of Receipt of Opioid Use Disorder-Related Telehealth Services and Medications for Opioid Use Disorder With Fatal Drug Overdoses Among Medicare Beneficiaries Before and During the COVID-19 Pandemic
This study examined the association between receipt of telehealth services and medications for opioid use disorder (OUD) and fatal drug overdoses before and during the COVID-19 pandemic among Medicare beneficiaries. The study found that the receipt of OUD-related telehealth services, receipt of medications for OUD from opioid treatment programs, and receipt of buprenorphine in office-base settings were all associated with reduced risk for fatal drug overdose.
Patient Characteristics Associated With Being Offered or Choosing Telephone vs Video Virtual Visits Among Medicare Beneficiaries
This goal of this study was to understand the characteristics of Medicare beneficiaries who received telephone-only telehealth visits when both telephone and video options were available. Results show Medicare beneficiaries often reported being offered or choosing telephone-only visits even when video visits were available.
Telemedicine adoption gradually rose prior to the COVID-19 pandemic, but the field saw a significant increase during the pandemic as a way for physicians to provide health services while limiting patient exposure to the virus. The widespread use of telemedicine could impact the quality, cost, and accessibility of health care, so it's important to understand its usage. This data brief documents rates of telemedicine use by office-based physicians, the types of tools used, physician characteristics, satisfaction levels, and plans to continue using telemedicine beyond the pandemic.
The COVID-19 pandemic resulted in the widespread availability of telemedicine services for children from primary care practices. This study is specifically focused on children who typically receive medical services in person while identifying factors that are linked to the usage of telemedicine services provided by primary care providers. Research outcomes reveal that promoting access to primary care, ensuring payment for primary care telemedicine, and removing obstacles in non-metropolitan areas can all contribute to the equitable use of primary telemedicine care for children.
This study investigates the quality of primary care delivered via telehealth in relation to equity among older adults across race and ethnicity in provider-shortage urban areas. The study examines the documentation of 4M (what matters, mobility, medication, and mentation) and self-reported racial and ethnic backgrounds in Southern Nevada. The findings indicate disparities, such as reduced documentation for what matters among Asian/Hawaiian/Pacific Islanders and mobility among Black individuals.
Inequitable access to general and behavioral healthcare in the US during the COVID-19 pandemic: A role for telehealth?
The COVID-19 pandemic had extensive consequences, including increased psychological distress and alcohol consumption, which created heightened challenges particularly for disadvantaged communities. To mitigate the impact of lockdowns, medical office closures, and fear of transmission, telehealth services were expanded early in the pandemic to provide continued access to health care. This study investigates the accessibility of general and behavioral health care services and disparities during the first year of the pandemic.
Telemedicine along the cascade of care for substance use disorders during the COVID-19 pandemic in the United States
The way healthcare services are provided has transformed because of the COVID-19 pandemic, which created an opportunity to advance telemedicine by formalizing clinical guidance. In this study, researchers aim to outline the delivery of substance use disorder (SUD) treatments and services through telemedicine along the continuum of care in the United States since the onset of the COVID-19 pandemic. This review summarizes telemedicine-based delivery, including screening/assessment, prescription, monitoring, recovery support and other related services.
Telemedicine Use and Quality of Opioid Use Disorder Treatment in the US During the COVID-19 Pandemic
There is limited understanding and knowledge about the potential consequences of the rapid shift to telehealth for opioid use disorder (OUD) treatment during the COVID-19 pandemic. The purpose of this study is to investigate the correlation between telemedicine utilization during the COVID-19 pandemic and indicators of OUD treatment quality. The results of this study indicate that patients who were treated by clinicians with both high and low levels of telemedicine usage had comparable clinical outcomes during the COVID-19 pandemic, which suggests that telemedicine is a viable substitute for in-person OUD care.
This study focuses on the use of telehealth during the peak of the COVID-19 pandemic, highlighting the clinical outcomes and characteristics of patients who utilized digital health services. Patients utilizing telehealth and telemedicine services are more likely to be young to middle-aged, female, White, of higher socioeconomic status, and living in urban settings.
Federally Qualified Health Centers Use of Telehealth to Deliver Integrated Behavioral Health Care During COVID-19
During the COVID-19 pandemic, Federally Qualified Health Centers (FQHCs) providing integrated behavioral health (IBH) services shifted to deliver care via telehealth. FQHC administrators reported that telehealth was essential and addressed workforce issues but noted concerns around payment parity and reimbursement and the impact on core components of IBH.
Nursing homes implemented telehealth services to adapt to the COVID-19 pandemic. This study found an increase in telehealth adoption. Training, integrated equipment, and staff presence during visits was identified as telehealth facilitators. Barriers included smartphone usage, billing issues, interoperability, and staffing challenges.
The goal of this research is to examine the outcomes in patient symptoms of anxiety and depression. Results show no clinical or statistical difference in depression or anxiety symptoms between patients treated via telehealth and in-person.
With the expansion and increase of telehealth during the COVID-19 pandemic, clinicians and patients faced the challenge of acclimating to virtual care through video visits. The study investigates the visit attendance for patients, comparing outcomes of those who received navigator outreach to those who did not. The results show visit attendance improvement for video visits after telehealth navigator outreach.
Rural health care is an ongoing research focal point as remote care, remote patient monitoring, and telehealth services continue to expand nationwide. This study assesses health care disparities, benefits, and the utilization of telehealth-supported provider-to-provider communication in rural populations through a systemic review of observational studies. Researchers assessed trials and observational studies from several medical databases to determine barriers for rural provider-to-provider collaboration, evidence gaps, and the key takeaways from their findings.
State Medicaid Telehealth Policies Before and During the COVID-19 Public Health Emergency: 2022 Update
This research highlights that state Medicaid programs have significant discretion in services delivered via telehealth. During the COVID-19 pandemic, all states and the District of Columbia utilized telehealth flexibilities provided by the Centers for Medicare & Medicaid Services. Some states made telehealth flexibilities permanent, while others let them expire. Additional research is needed to assess the impact of increased telehealth utilization in Medicaid on access to care, utilization rates, and quality of care.
This research study explores the potential of using miniaturized sensors and other technologies to collect physiological and functional data directly from pediatric patients participating in clinical trials. The review discusses the advantages and disadvantages of these technologies in various pediatric diseases, highlighting the need for more reports on their use in this population. While the objective and frequent measurements provided by digital health technology offer opportunities to enhance drug evaluation in infants and young children, challenges remain in selecting the appropriate design, metrics, and sensors for each disease.
Low-Volume Emergency Departments are More Likely to Use Telehealth for Sepsis Care in a National Rural Telehealth Network
Low-volume emergency departments (EDs) have higher rates of mortality as compared to higher volume EDs. This multicenter, retrospective study evaluated the prevalence of tele-ED use for sepsis care to understand variations across rural EDs and identify factors that predict the need for sepsis consultation using telemedicine.
This study assessed the use of telehealth by Medicaid MCOs to provide pediatric care. The researchers analyzed variations in telehealth use based on geography, race, and ethnicity and identified the health conditions and services that accounted for the greatest percentage of telehealth visits for children enrolled in Medicaid MCOs.
Telehealth and Public Health Practice in the United States- Before, During and After the COVID-19 Pandemic
In 2020, the Centers for Disease Control and Prevention (CDC) established a telehealth unit as part of its COVID-19 emergency response and a CDC telehealth workgroup. The workgroups identified ways that telehealth can benefit public health including increasing access to reduce health disparities, enhancing disease management and preventative care, and triaging care to ensure appropriate use of health services.
Association Between In-Person vs Telehealth Follow-up and Rates of Repeated Hospital Visits Among Patients Seen in the Emergency Department
Improved patient mortality is associated with the promptness of follow-up visits from the emergency department (ED). Although in-person follow up visits after ED discharges are known to be effective, the success of telehealth as a follow-up option is unspecified. This cohort study examines the difference in the rates of patients who were discharged from the ED and have an in-person follow-up in comparison to those patients who have telehealth follow-up appointments.
Association of Adequacy of Broadband Internet Service with Access to Primary Care in the Veterans Health Administration Before and During the COVID-19 Pandemic
While the Veterans Health Administration (VHA) offered several telehealth services before the pandemic, the use of telehealth by veterans significantly increased during the COVID-19 pandemic. An analysis of data from VHA found that veterans who lived in communities with limited or no access to broadband were less likely to access primary care via telehealth during the pandemic. Reduced access to broadband was associated with neighborhood-level social disadvantage, worsening access disparities.
This study focused on the use of palliative primary care using telehealth and hybrid models during the pandemic. The research findings suggest that the use of telehealth may expand the availability of palliative care for individuals and their families who are not conveniently located near a health center that offers this important service. The authors note that telehealth may be more appropriate for some palliative care services than for others.
Receipt of Telehealth Services, Receipt and Retention of Medications for Opioid Use Disorder, and Medically Treated Overdose Among Medicare Beneficiaries Before and During the COVID-19 Pandemic
To ensure access to substance use disorder services during the pandemic, the government authorized the use of telehealth to prescribe and manage medications for opioid use disorder (MOUD). This study looked at over 150,000 Medicare beneficiaries living with OUD during the pandemic and found that MOUD prescribing via telehealth improved retention in an OUD-treatment program using prescribed medication and reduced the likelihood of medically treated overdose.
Targeted Telehealth Education Increases Interest in Using Telehealth among a Diverse Group of Low-Income Older Adults
Telehealth has the potential to empower older adults to have more autonomy over their health, but they are less likely to use telehealth. This research study focuses on an education program targeting vulnerable, low-income, minority older adults. Results show that the program increased their confidence in accessing and using telehealth, resulting in improved health promotion and achieving the aim of promoting telehealth use among this population.
This research study addresses the need for comprehensive evaluation of telehealth outcomes and performance, considering access to care, cost, experience, and effectiveness. The study emphasizes the understudied aspects of telehealth accessibility and accommodations and highlights the importance of establishing an evaluation system for telehealth outcomes.
Telehealth use has skyrocketed since the onset of the COVID-19 pandemic, yet evaluating the outcomes has proven to be a challenging task. This research study proposes novel survey questions to design a telehealth evaluation system and determines crucial outcome measures across four domains: access, cost, experience and effectiveness. Additionally, this research presents tools to reach priority populations such as older adults, people with disabilities, and underrepresented minorities who often lack access to remote care.
Certain Medicare Beneficiaries, Such as Urban and Hispanic Beneficiaries, Were More Likely Than Others to Use Telehealth During the First Year of the COVID-19 Pandemic
This data brief examines the characteristics of Medicare beneficiaries who used telehealth during the first year of the pandemic. This report discusses how the temporary expansion of telehealth impacted various beneficiary groups. In addition, the learnings can help to inform future work in increasing beneficiary access to telehealth.
Effect of a Comprehensive Telehealth Intervention vs Telemonitoring and Care Coordination in Patients With Persistently Poor Type 2 Diabetes Control
This study addresses poorly controlled type 2 diabetes by comparing simple and comprehensive telehealth interventions. The trial shows that comprehensive telehealth is more effective than telemonitoring and care coordination, improving outcomes for patients at a reasonable cost. These findings suggest that implementing comprehensive telehealth could enhance diabetes care.
The use of digital health technologies including telehealth and mhealth expands access to health care as well as education and the ability to access resources to improve overall health such as housing and employment. This study discusses how digital health technologies can reduce disparities in quality of care for transgender individuals.
This research study analyzed HIV care appointments at an urban tertiary hospital to assess the uptake of telehealth and sociodemographic variations in utilization among people with HIV. The findings indicated age and racial differences in terms of in-person versus telehealth appointments.
Adoption of telemedicine in a rural United States cancer center amidst the COVID-19 pandemic: A qualitative study
Oncology, the branch of medicine that deals with the diagnosis and treatment of cancer, has been slower than other fields of medicine to utilize telemedicine. This study aims to better understand the different factors that affect provider and patient hesitancy for telemedicine uptake and sustained use in oncology. Overall, providers favored telemedicine utilization for lower-acuity cancer care visits that were less dependent on physical exams, and more focused on patient education. The results give researchers important data that can aid in the improvement of virtual cancer care, giving the opportunity for increased access to rural and underserved communities.
The goal of this study is to assess the technical feasibility and acceptability of using telehealth for palliative care consultations in nursing homes. The findings demonstrated that palliative care video visits were well-received, with participants expressing comfort, improved communication, and potential future use, highlighting the value of telehealth as a cost-effective means to enhance access to palliative care services in nursing homes.
Mindfulness-Based Smoking Cessation Delivered Through Telehealth and Text Messaging for Low-Income Smokers: Protocol for a Randomized Controlled Trial
Telehealth has the potential to widely expand patient access to the intervention and treatment for tobacco usage. Low-income minority groups often struggle with quitting due to a lack of healthcare infrastructure around smoking cessation interventions, and therefore experience tobacco-related health problems at a greater rate. This study uses telehealth sessions and SMS text messaging to deliver mindfulness-based smoking cessation treatment, with the hope of reaching population groups that normally do not have access to in-person treatment centers. Data will continue to be collected until the spring of 2024.
This systematic review looked for studies that compare use and outcomes of in-person and telehealth care for chronic care management of congestive heart failure, chronic obstructive pulmonary disease, and type 2 diabetes mellitus.
Telehealth services have been utilized in type 1 diabetes (T1D) clinical care for years, but the COVID-19 pandemic accelerated adoption and sparked interest in long-term integration into routine care. This review examines the existing literature on telemedicine in T1D care, highlighting its benefits and barriers. The findings indicate that telehealth can effectively contribute to improved glycemic control and long-term outcomes in T1D and it is anticipated that future care models will adopt a hybrid approach combining both in-person and telehealth visits.
"I was Unsure at First": A Qualitative Evaluation of Patient Perceptions of VA Clinical Video Telehealth Visits in the V-IMPACT Program
Many veterans have skepticism about telehealth. This study examines how veteran’s opinions of telehealth change once they experience a virtual appointment. Findings show a wide variety of patient responses to telehealth appointments, and these experiences offer an opportunity for future telehealth providers to better understand the needs of their patients to make virtual care as effective and supportive as possible.
Parent-Child Interaction Therapy-Health (PCIT-Health) is a form of behavior parent training that focuses on helping parents learn skills for better managing a child’s behavior, including obesity-related behaviors. This study examines the experience of one family using telehealth to receive PCIT. The results show that the family had a positive experience with telehealth-delivered PCIT, and that the parent’s skillset of positive parenting practices increased. This study gave researchers more information on patient experience with telehealth-delivered PCIT so that in the future there can be a wider implementation of this practice for improving child behavioral problems.
Association between state payment parity policies and telehealth usage at community health centers during COVID-19
Parity policies are the combined amount of reimbursement that a health benefit plan allows for the compensation to the distant site and the originating site which are required to not be less than the total amount allowed for healthcare services provided in-person. This study highlights the association between payment parity policies and the use of telehealth at community health centers, particularly during COVID-19.
Buprenorphine is a medication used for patients who struggle with opioid use disorder, but only about 1 in 5 patients receive treatment. The COVID-19 pandemic increased telehealth utilization for addiction treatment with studies supporting telemedicine as an effective way to deliver treatment for opioid use disorder. This study aims to identify the percentage of the US population that experience challenges with treatment accessibility. Barriers to treatment that are examined in this study include limited internet access and the number of buprenorphine-waivered providers near a patient’s residence.
The Owen Clinic at UC San Diego Health developed a telemedicine clinic in response to the COVID-19 pandemic to ensure the continuity of care for patients with human immunodeficiency virus (HIV), and other high-risk populations. This study gives an in-depth review of the Owen Clinic and various virtual-medical services it provided throughout the pandemic that ultimately were effective in treating and monitoring high-risk patients.
Expanding access to substance use services and mental health care for people with HIV in Alabama, a technology readiness assessment using a mixed methods approach
Due to Alabama's vast amount of rural area, there are many obstacles that patients can face while trying to receive treatment for HIV. Specifically, HIV patients often experience challenges with access to treatment for mental health and substance use disorders (SUD) due to a lack of public health infrastructure and limited amounts of health care providers near their residence. This study examines if adopting telehealth screenings for mental health and SUDs can improve rural patients access to healthcare services.
Improving heart failure care and guideline-directed medical therapy through proactive remote patient monitoring-home telehealth and pharmacy integration
This study evaluates the use of remote patient monitoring (RPM) home-telehealth and pharmacist consultations on high-risk cardiovascular patients, with the overall goal being a reduction in hospital admissions due to heart failure. A registered nurse, cardiovascular physician, and pharmacist all play a crucial role in care delivery during this study, working together to improve guideline-directed medical therapy (GDMT) prescription. Results from this study show that the number of patients who maximized GDMT care increased, which may have assisted in the reduction of hospital admissions due to heart failure during the study.
Managing innovation: a qualitative study on the implementation of telehealth services in rural emergency departments
This study focuses on the integration of telehealth services for emergency departments in rural areas and highlights gaps in the implementation and long-term utilization. Researchers administered semi-structured interviews from six U.S. health care systems that provided emergency telehealth services. Results include necessary implementation factors in strategies, capability, relationships, financials, protocols, environment, service characteristics, and accountability.
The impact of the COVID-19 pandemic on people who inject drugs accessing harm reduction services in an rural American state
Harm reduction services, such as syringe service programs (SSPs), shelters, peer support groups, and low barrier buprenorphine treatment are services for people who inject drugs (PWID) and their recovery process. Prior to the COVID-19 pandemic, PWID faced many challenges with access to these services, but the pandemic exacerbated these barriers even further. This study examines the impact that COVID-19 had on access to harm-reduction services, specifically for Maine residents.
The study aimed to investigate the discrepancy in the adoption of telestroke and pediatric telehealth services in emergency departments. The researchers hypothesized that differences in financial incentives, prehospital routing policy, and certification requirements could have contributed to the uneven adoption. The study shows the most frequently indicated reason for adoption of telehealth services was related to clinical care.
Association Between Telemedicine Use in Nonmetropolitan Counties and Quality of Care Received by Medicare Beneficiaries With Serious Mental Illness
For people diagnosed with serious mental illnesses such as schizophrenia, bipolar I disorder, and other related psychotic disorders, accessibility to specialty mental health care services is an ongoing barrier. This cohort study explores the association between greater telemental health service use in a nonmetropolitan county and quality measures including 118,670 patients diagnosed with schizophrenia, bipolar I disorder, and/or related psychotic disorders. This includes the use of specialty mental health care and medical adherence of patients with schizophrenia or related psychotic disorders. Results from the study reveal slight increases in encounters with outpatient specialty mental health professionals and increased possibility of follow-up after being hospitalized.
Behavioral healthcare organizations' experiences related to use of telehealth as a result of the COVID-19 pandemic: an exploratory study
The COVID-19 pandemic resulted in many behavioral health services having to transition to deliver care virtually via telehealth. This study analyzes the experiences of behavioral health organizations that used telehealth during the pandemic to determine any common themes. Results show that organizations viewed convenience, increased access to disadvantaged populations, and lack of commute as advantages of telehealth; common disadvantages included limited access to technology and possible ineffective treatments.
Since the use of telehealth in outpatient endocrinology is likely to remain common after the COVID-19 pandemic, this study examines how endocrinologists determine clinical appropriateness for telehealth and identifies their strategies to navigate barriers to safe and effective use. This research is crucial due to the absence of guidelines on telehealth use in this field, and the findings show the need for expert guidance to anchor future evidence-based guidelines for determining clinical appropriateness of telehealth in endocrinology.
Due to the COVID-19 pandemic, many educational environments had to transition to virtual learning, including teaching hospitals for medical students. This study evaluates one hospital’s transition to using telehealth for a new learning program that allows students to become familiar with clinician and patient perspectives of different care models. The curriculum specifically focuses on using virtual care in the multidisciplinary field of addiction medicine.
Factors influencing uptake of telemental health via videoconferencing at high and low adoption sites within the Department of Veterans Affairs during COVID-19: a qualitative study
The purpose of this study is to determine factors that influence site-level uptake of telemental health via videoconferencing (TMH-V) by examining both a low adoption site and a high adoption site within the US Department of Veterans Affairs. Findings show that while there are many positive and negative influencers of TMH-V uptake, the biggest influencer was site complexity. User-friendly sites that are accessible to patients with a limited technology skill set positively affect site uptake. Unfortunately, a majority of the sites examined were not user-friendly, so complexity had an overall negative influence. Understanding the various influencers of site-level uptake allows for improvement on future implementation, overall increasing patient access to virtual mental health care.
Long-term Effects of Remote Patient Monitoring in Patients Living with Diabetes: A Retrospective Look at Participants of the Mississippi Diabetes Telehealth Network Study
This study examines the effectiveness of long-term remote patient monitoring (RPM) for patients with diabetes in the state of Mississippi. While RPM has been proven to be an effective tool for monitoring patient’s hemoglobin A1C levels, the ability of RPM to support patients in maintaining treatment is unclear. Many participants experienced reductions in hemoglobin levels after 12 months of nurse coaching and diabetes self-management education that were provided via telehealth, indicating that RPM could be an important tool in managing chronic diseases, specifically diabetes.
Parent satisfaction with the parent-provider partnership and therapy service delivery for children with disabilities during COVID-19: Associations with sociodemographic variables
Parents of children with disabilities played a huge role in facilitating the continuity of care for their children throughout the COVID-19 pandemic, especially through managing and delivering therapies remotely. This study aims to examine the relationship between sociodemographic factors and parent satisfaction with the delivery of therapy services for children with disabilities during the pandemic. Factors impacting parents' satisfaction with therapy services included access to telehealth services, number of household essential workers, number of children, parent education, and more.
This study aimed to understand the preferences of gynecologic cancer survivors for telehealth cancer care. Over half preferred in-person visits. Many noted concerns about missing out on physical examination during telehealth visits. The study highlights the need for careful evaluation of patient concerns and education to develop future care models that include telehealth elements for gynecologic cancer survivors.
Perceptions and Use of Telehealth Among Mental Health, Primary, and Specialty Care Clinicians During the COVID-19 Pandemic
The purpose of this study was to capture healthcare providers attitudes towards telehealth utilization during the COVID-19 pandemic, since physician’s attitudes may impact utilization rates of telehealth by patients. Findings show differences in video, phone, and in-person care utilization across specialties, as well as clinicians attitudes towards telehealth having an impact on patient utilization.
Predictors of telemedicine use during the COVID-19 pandemic in the United States-an analysis of a national electronic medical record database
Although telehealth utilization has rapidly increased within the past years, disadvantaged groups still face barriers to access. This is a retrospective study that analyzes outpatient medical encounters for patients using a national electronic medical record database from March 1 to December 31, 2020. Findings show that older and non-Hispanic Black patients had significantly lower levels of telehealth utilization than other patient groups.
Public health implications of adapting HIV pre-exposure prophylaxis programs for virtual service delivery in the context of the COVID-19 pandemic: a systematic review
Based on a systematic review, the authors suggest a virtual service delivery model for PrEP that can be leveraged for the COVID-19 public health emergency using the internet and social media for demand creation, community-based self-testing, telehealth platforms for risk assessment and follow-up, applications for support groups and adherence/appointment reminders, and applications and internet for monitoring.
This is a systematic review that examines the role that telehealth can play in the future of antenatal care. Various factors that could facilitate or create a barrier in the implementation of telehealth for antenatal care were also reviewed. Studies reviewed show that there were no differences in the amount of preterm births or neonatal intensive care unit admissions when comparing telehealth and in-person visits, and that both patients and providers are open to telehealth utilization in this field, but more research is needed.
Strategies to Ensure Continuity of Care Using Telemedicine with Older Adults during COVID-19: A Qualitative Study of Physicians in Primary Care and Geriatrics
This study examines the utilization of telehealth by patients aged 65 and older during the COVID-19 pandemic, as well as explore the experiences of primary care physicians and geriatricians by conducting interviews. Examining various strategies used to maintain the care of patients aged 65 and older throughout the pandemic allows for future improvement of telehealth utilization for geriatricians. Findings indicate the importance of evaluating a patient's technological readiness in advance, making accommodations for disabilities, and involving caregivers throughout the telehealth experience.
This study evaluated the effectiveness, use, and implementation of telehealth for women's preventative services for reproductive healthcare and interpersonal violence (IPV), and to evaluate patient preferences and engagement for telehealth, particularly in the context of COVID-19. Three of the 16 studies indicated that telehealth utilization increased during COVID-19 public health emergency.
The Lack of a Physical Exam During New Patient Telehealth Visits Does Not Impact Plans for Office and Operating Room Procedures
This study examines if surgical plans made during a telehealth visit remain unchanged after a pre-operative examination immediately before surgery. Data for this study was gathered during the COVID-19 pandemic on urology patients. Results show that majority of surgical planning made during new patient visits stayed the same after in-person examinations, signaling that telehealth can be a useful tool in the future for virtual surgical planning.
Due to the COVID-19 pandemic, telehealth has experienced many updates in the past 3 years. These innovations have presented a new opportunity in the health care field for utilization of new ways to remotely monitor medically complex patients This study uses clinical informatics linked to inpatient and emergency department use to evaluate telehealth utilization of various population segments. Results show that there is potential to improve patient outcomes using telehealth in the primary care and acute care settings, as well as decrease emergency department and inpatient utilization.
Using Implementation Science to Understand Teledermatology Implementation Early in the COVID-19 Pandemic: Cross-sectional Study
Due to the COVID-19 pandemic, the use of telehealth in dermatology practices (teledermatology) has experienced rapid expansion. Implementation science uses evidence-based practices to improve the quality and effectiveness of healthcare services, and this study aims to understand more about how implementation science can be used in dermatologic care, as well as in teledermatology. Results from this study give health care providers insight on how to successfully continue the use teledermatology after the pandemic.
Addressing Hypertension Outcomes Using Telehealth and Population Health Managers: Adaptations and Implementation Considerations
This study examines various population health approaches to help with hypertension management. Telehealth is one approach that this study focuses on, with it being a cost-effective strategy that addresses multiple barriers to hypertension utilization and care delivery. Results show that telehealth is an effective strategy for advancing hypertension care within a population health paradigm by addressing multiple drivers of high blood pressure.
An Economic and Health Outcome Evaluation of Telehealth in Rural Sepsis Care: A Comparative Effectiveness Study
Sepsis is one of the top reasons for hospital mortality and healthcare costs. Telehealth has been shown to improve short-term sepsis care; however, the effect on costs and long-term outcomes is unclear. This study compares costs and outcomes for sepsis treated in rural emergency departments.
Describing Changes in Telebehavioral Health Utilization and Services Delivery in Rural School Settings in Pre- and Early Stages of the COVID-19 Public Health Emergency
Due to significant provider shortages, challenges exist for patients attempting to receive behavioral health services especially in light of the COVID-19 pandemic. In this study, researchers collected data from students in fifteen school-based telehealth programs in rural areas nationwide. Results of the study show increased utilization and implementation of telebehavioral services in school-based programs as a direct response to the effects of the COVID-19 pandemic.
This is a technical brief that examines the potential of mobile application (app) utilization for mental health and wellness services. Although there are many mobile apps available for mental health services, there is little guidance that consumers and patients can use when trying to determine what application to use. This brief also provides a framework to assess apps based on different strengths and limitations.
Postpartum during a pandemic: Challenges of low-income individuals with healthcare interactions during COVID-19
The COVID-19 pandemic resulted in many changes in women’s healthcare delivery for childbirth and the postpartum period, but these changes particularly affected low-income patients. This study examines various challenges that low-income patients experienced during the pandemic.
This report defines common telehealth terms across a variety of contexts (clinicians, academia, federal stakeholders) and explains why it is important to use terminology that is contextually appropriate. Most patients will not distinguish between the terms “telehealth” and “telemedicine” in their use. Academic researchers may need to distinguish the terms to accurately describe and frame their research. Among federal stakeholders, telehealth is currently the most used term and would have the most recognition.
Telemedicine versus in-Person Primary Care: Impact on Visit Completion Rate in a Rural Appalachian Population
The purpose of this study is to understand the affects that telehealth has on patient access and visit completion rates for primary care in a rural community. While the COVID-19 pandemic increased telehealth utilization and availability, little research has been done to determine if the increased availability of virtual care has actually improved access to healthcare in rural and underserved areas. Findings from this study show that the introduction of telehealth in these rural communities created an increase in appointment completion by 20%, indicating that there was an overall increase in patient access.
The Potential of Telecommunication Technology to Address Racial/Ethnic Disparities in HIV PrEP Awareness, Uptake, Adherence, and Persistence in Care: A Review
The purpose of this review was to understand how studies have used electronic telecommunication technology to increase awareness, uptake, adherence, and persistence in PrEP care among Black and Hispanic/Latino persons and how it can reduce social and structural barriers that contribute to disparities in HIV infection.
The COVID-19 pandemic made telehealth an essential service for health care access which led to the development of temporary policies with varying definitions and regulations by state and organization. Currently, more permanent guidelines are being established which has provided an opportunity to re-evaluate how telehealth is integrated into regular health care delivery. By defining a clear understanding of telehealth and its components, the clinical care can improve and more precise control and expectations for researchers, patients and providers can be implemented.
Temporary telehealth policies were developed by various organizations and states during the COVID-19 emergency, with varying definitions, regulations, and coverage. As these policies are being replaced with more permanent guidelines, there is an opportunity to form a consensus in definitions to set a standard of care.
In the early stages of the COVID-19 pandemic, states and the federal government quickly implemented policy changes to expand access to health care. As a result, the definition of telehealth and the services included varied across entities. The researchers discuss the implications of this variance which will impact policy and research and hinder efforts to address health disparities. As a result, efforts must be made to establish a single definition for telehealth that is consistently used.
Direct and indirect effects of a Project ECHO longitudinal clinical tele-mentoring program on viral suppression for persons with HIV: a population-based analysis
Project ECHO tele-mentoring for community providers was associated with improvement in viral suppression for people with HIV whose providers participate or work in the same clinic system as a provider who participates.
The pandemic increased the use of tele-urgent care to improve timely access to health care while preventing unnecessary, in-person contact. This research study reviewed the literature to determine whether tele-urgent care might be an effective substitute for in-person care for low-acuity conditions in the future. While there was no evidence of costs savings, the research suggests that tele-urgent care may increase access by triaging patients to the right level of care.
Disasters of all scales are a recurring issue and challenge for the health care systems, especially for providers and hospitals nationwide. The utilization of telemedicine is a direct response to improve access to health care during disasters, which is referred to as disaster telemedicine. This study focuses on literature that provides insight and response recommendations into the current use of disaster telemedicine for the most common barriers in regional disaster health.
Telehealth and the use of telehealth for stroke treatment and services is considered be cost-effective, specifically for its use and ability to provide timely treatments. This study reviews multiple telestroke programs to identify how other and existing programs can implement and sustain their telestroke services and programs.
Child Health, Vulnerability, and Complexity: Use of Telehealth to Enhance Care for Children and Youth With Special Health Care Needs
Telehealth has the potential to improve the quality of care, particularly deficiencies related to access and patient experience of care for children and youth with special health care needs and reduce disparities related to accessing in-person care.
Deploying a telemedicine collaborative care intervention for posttraumatic stress disorder in the U.S. Department of Veterans Affairs: A stepped wedge evaluation of an adaptive implementation strategy
This study uses two strategies, standard implementation and enhanced implementation, to determine the best way to incorporate telehealth utilization in trauma-focused psychotherapy for veterans with post-traumatic stress disorder (PTSD). Results show that although telehealth is an effective means for engaging veterans in treatment, neither of these strategies were successful at incorporating telehealth into routine care treatment of PTSD.
mHealth Interventions for Self-management of Hypertension: Framework and Systematic Review on Engagement, Interactivity, and Tailoring
The prevention or management of hypertension is an area of interest for researchers. This systematic review explores user engagement for hypertension-focused mobile health (mHealth) interventions as well as tailoring and interactivity for mHealth users. Digital behavior change interventions require engagement to be effective for users.
The risk of suicide among American Indian and Alaskan Native Communities during the COVID-19 pandemic significantly exceeded that of other racial and ethnic groups. Telehealth is an effective way to deliver behavioral health services in these communities. This study assessed Montana-based provider perceptions of the potential for telehealth to reduce suicides and the implications for future research.
Telehealth Use Among Older Adults During COVID-19: Associations with Sociodemographic and Health Characteristics, Technology Device Ownership, and Technology Learning
While the number of older adults using telehealth increased significantly during the COVID-19 pandemic, adoption and use of this care modality lagged that of younger adults. In this study, the authors investigate the factors that contribute to this discrepancy and discuss the implications.
Telemedicine and visit completion among people with HIV during the COVID-19 pandemic compared to pre-pandemic
During the COVID-19 public health emergency, telemedicine visit completion among people with HIV increased significantly, especially among populations with lower pre-pandemic engagement.
Empowerment through technology: A systematic evaluation of the content and quality of mobile applications to empower individuals with cancer
Mobile health application availability has increased for cancer patients due to a focus on patient empowerment. This systematic review evaluates and summarizes the evidence of mobile health apps and their characteristics and qualities. The evaluation found that cancer patient apps should be designed for usability and usefulness for a diverse group.
Evaluation of Online Patient Portal vs Text-Based Blood Pressure Monitoring Among Black Patients With Medicaid and Medicare Insurance Who Have Hypertension and Cardiovascular Disease
There is a considerable issue of unmonitored hypertension and cardiovascular disease among Black patients. Twenty Black patients with Medicaid and Medicare insurance who have hypertension and cardiovascular disease (CVD) or CVD risk factors were enrolled in this randomized pilot clinical trial. Researchers assessed the increased use and acceptability of a text-based model for home blood pressure (BP) monitoring compared with online portal use. When combined with telemonitoring, self measured BP is associated with improved BP control, although disparities in telemedicine access may limit the beneficial outcomes of home BP monitoring for Black patients.
National Survey Trends in Telehealth Use in 2021: Disparities in Utilization and Audio vs. Video Services
This report analyzes national trends in telehealth utilization and how use of video-enabled vs. audio-only telehealth services differ across patient populations. The study finds notable disparities by race, ethnicity, income, age, and insurance status in access to video-enabled telehealth.
This study aims to successfully develop a synchronous telehealth exercise intervention program for people with HIV to improve cardiorespiratory fitness.
During the COVID-19 pandemic, in-person health care visits dramatically decreased, and the utilization of telehealth services increased. The purpose of this study is to examine various patterns in telehealth utilization based off certain factors, including geographical location, type of health care service, and a patient’s age, race, and income.
Access to providers who are qualified to diagnose autism-spectrum disorder (ASD) is challenging for parents of children who show signs of ASD. Telehealth has increasingly been used as a resource to decrease the wait time for early diagnosis and increase timely access to services. Overall, caregivers were satisfied with telediagnostic assessment, but the researchers identified variation including experience and accuracy of the diagnosis.
A Pilot Study Examining Access to and Satisfaction with Maternal Mental Health and Substance Use Disorder Treatment via Telemedicine
It is common for women to experience mental health problems and substance use disorders (SUDs) while pregnant and during the postpartum year. Unfortunately, many women are not able to receive proper treatment for these problems due to barriers to care, but using telehealth as a tool to increase access is one way to combat this. This study was conducted to evaluate patient satisfaction with their accessibility to proper treatment for these disorders, as well as their experiences with this care being delivered via telehealth. Results show that women receiving mental health and SUD treatment via telemedicine within their obstetrician's office had high levels of satisfaction, and that it significantly increased access to care.
Evaluation of a telemedicine pilot program for the provision of HIV pre-exposure prophylaxis in the Southeastern United States
In this telePrEP feasibility study, adherence to PrEP remained high and most participants preferred telemedicine or a combination of telemedicine and in-person office visits to only in-person office visits. Without this program, many participants were unlikely to have received PrEP.
People with HIV and clinical staff perceive telemedicine visits as useful, with benefits including the ability to engage and re-engage patients in care, perceived patient-centeredness and flexibility, the opportunity to engage family and multidisciplinary care team members, and the opportunity to enhance telemedicine use proficiency through practice and support.
Patient Experience with In-Person and Telehealth Visits Before and During the COVID-19 Pandemic at a Large Integrated Health System in the United States
The positive experiences with telehealth reported in this study, especially video based telehealth, may be due to patient appreciation of efforts made to maintain access during the COVID-19 public health emergency, the focused nature of telehealth visits, and help by staff for navigation technical issues.
Rapid Implementation of a Telemedicine Program in a Ryan White–Funded HIV Clinic During a Global Pandemic
With the introduction of telemedicine in an HIV clinic, the average monthly number of patient encounters increased, the mean no-show rate decreased, and viral suppression increased. Patient satisfaction also increased during this period.
Tele-audiology can reduce barriers to hearing care by increasing access to care and reducing barriers such as time and travel. This study reviewed existing literature that found audiology services like hearing screenings, diagnostic tests, and rehabilitation can be safely delivered via telehealth and increase access to individuals who may otherwise have limited access to a hearing specialist.
The use of telehealth by primary care providers has evolved over the past several years. Using survey data, this study examined changes in the use of telehealth by primary care physicians. The study delineated physician characteristics associated with primary care providers that plan to continue using telehealth versus those who indicated that they are likely to discontinue the use of telehealth.
Use of Telehealth Services for Prenatal Care in Mississippi: Comparison of Pre-COVID-19 Pandemic and Pandemic Obstetric Management
There has been little research to examine the use of telehealth during the COVID-19 public health emergency and its impact on the delivery of care during pregnancy and outcomes associated with pregnancy. This study examines prenatal care practices during the height of the first wave of the COVID-19 public health emergency, compared to the immediate pre-pandemic time period, and explores maternal and birth outcomes during these time periods.
Brief Report: Supporting Access to HIV Care for Children and Youth During the COVID-19 Pandemic With Telemedicine and Rideshare
Telemedicine has the potential to bridge pediatric health care gaps. Telemedicine combined with rideshare support ensured uninterrupted access to HIV care among pediatric and adolescent patients.
Medicare Beneficiaries’ Use of Telehealth in 2020: Trends by Beneficiary Characteristics and Location
This research report examines changes in Medicare fee-for-service Part B visits and the use of telehealth in 2020 during the COVID-19 public health emergency by beneficiary characteristics, provider specialty, and location.
The COVID-19 pandemic led to rapid expansion of telemedicine services, and the purpose of this study is to better understand perceptions of telemedicine and compare parent/guardian satisfaction between in-person and telemedicine encounters.
Technology Support Challenges and Recommendations for Adapting an Evidence-Based Exercise Program for Remote Delivery to Older Adults: Exploratory Mixed Methods Study
During the pandemic, a growing number of older adults with chronic conditions accessed exercise classes through videoconferencing technology to help meet their clinician’s recommendations for fitness. While users of a tele-exercise program found it helpful, technology barriers such as access to a webcam, experience using videoconferencing, and ability to troubleshoot technology were identified as barriers to participation.
Telehealth for HIV Care Services in South Carolina: Utilization, Barriers, and Promotion Strategies During the COVID-19 Pandemic
Telehealth was used to provide a wide array of medical and supportive HIV services, including case management, support groups, housing, food, and transportation services. Staff education, cell phone distribution, client empowerment and technology use guidance, bureaucracy and process adjustments, and reimbursement changes are all strategies that could further facilitate telehealth use to deliver care and treatment to people with HIV.
Regional partnerships between public health organizations and telehealth programs have the potential to expand access to HIV pre-exposure prophylaxis in rural and small urban areas, but the best practices on how to successfully conduct these partnerships are unknown. Iowa TelePrEP is a regional public health‒partnered telehealth model created by the Iowa Department of Public Health and the University of Iowa to assess barriers and facilitators to statewide expansion and the lessons learned in the process. The facilitators of expansion included early public health partner engagement, model acceptability and inclusion of a navigator, and adaptability to local public health partner settings.
Development and Preliminary Feasibility of iByte4Health: A Mobile Health (mHealth) Pediatric Obesity Prevention Intervention to Engage Parents with Low-Income of Children 2-9 Years
Pediatric obesity continues to be a major public health concern with minority, low-income youth most at risk. This study assesses the use of mobile health (mHealth) programs such as iByte4Health, a text-messaging based obesity prevention program. The goal of iByte4Health is to deliver patent and child-focused content which encourages conversations towards key health behaviors, goals, and behavioral changes.
In Georgia, HIV telehealth has been successful at bridging gaps in patient care and in training local providers to offer comprehensive HIV care. A total of 60 telemedicine solutions were deployed in Georgia to expand HIV care access in 12 Georgia health districts. Among Ryan White HIV/AIDS Program clients who had a telehealth visit, 99.4% were prescribed antiretroviral therapy and 91.4% were virally suppressed.
Many rural areas have a shortage of health care professional to meet the needs of the community. Several schools located in rural areas have implemented telehealth solutions to address the unmet health needs of students. This study captures insights from telehealth programs funded through the School-Based Telehealth Network Grant Program to identify facilitators and barriers to inform implementation of telehealth programs in rural schools.
Telehealth has seen significant growth as a health care delivery method, specifically among advanced practice nurses. With lack of standardized telehealth training, advanced practice nurses are not equipped to maximize use of telehealth to provide care for patients. In this research, the Four P’s of Telehealth framework (planning, preparing, providing, and performance evaluation) was used to identify, develop, and evaluate telehealth competencies. Effective use of these competencies to guide training development will provide the necessary education and tools needed to assume leadership roles in all phases of telehealth implementation and delivery.
In a study of 10.4 million rural Medicare beneficiaries, researchers discovered continuous growth in telemedicine use among Medicare beneficiaries with a disproportionate share of all telemedicine visits for serious mental illness (e.g., bipolar disorder) between 2010 and 2019 – especially for care provided by nurse practitioners and other non-physician clinicians.
While the COVID-19 pandemic added new challenges within the medical field, it also presented new opportunities, such as catalyzing the implementation of telehealth within spaces that offer care for people living with HIV, substance use disorders, and various behavioral health problems.
The pandemic led to an expansion of telehealth access for individuals receiving Medicaid across the United States. Based on Medicaid claims data, the authors discuss the growth in telehealth use by Medicaid and Children’s Health Insurance Program (CHIP) recipients. The report also analyzes state policies for telehealth reimbursement under Medicaid and discusses how these changes are likely to impact access and health equity.
Keeping Pace With 21st Century Healthcare: A Framework for Telehealth Research, Practice, and Program Evaluation in Occupational Therapy
The use of telehealth in occupational therapy is steadily increasing, but there is little framework around the evaluation of these services. This study introduces the PACE Framework, which aims to support researchers and practitioners in systematically evaluating components of telehealth service delivery in occupational therapy through population and health outcomes, access for all clients, costs and cost-effectiveness, and the experiences of clients and occupational therapy practitioners.
Telehealth for HIV Care Services in South Carolina: Utilization, Barriers, and Promotion Strategies During the COVID-19 Pandemic
This study examines telehealth utilization for HIV services in South Carolina, identifies barriers to telehealth during the COVID-19 public health emergency, and investigates strategies to facilitate remote HIV care delivery.
This guide reviews the research on the effectiveness of using telehealth for serious mental illness and substance abuse disorders. It makes recommendations for practice and provides examples of how practitioners use these practices in their programs.
Seeing the Value of Video: A Qualitative Study on Patient Preference for Using Video in a Veteran Affairs Telemental Health Program Evaluation
A web-based treatment program for veterans utilizes video visits with mental health experts to conduct online cognitive behavioral therapy that targets treating clinically significant symptoms of depression and post-traumatic stress disorder. This program evaluated whether or not veterans thought that using video during these sessions is important, and why it may or may not be important. Results show that being able to visually see a provider has distinct benefits for care and the patient-provider relationship, which gives important information for future telehealth use when debating whether to use video or phone for remote care.
Comparative effects of telephone versus in-office behavioral counseling to improve HIV treatment outcomes among people living with HIV in a rural setting
People with HIV at risk for discontinuing HIV care and treatment failure living in rural areas expressed a preference for telephone-delivered behavioral counseling and those who received telephone counseling completed a greater number of sessions.
Evaluation of an Intrahospital Telemedicine Program for Patients Admitted With COVID-19: Mixed Methods Study
In this study, virtual care was associated with reductions in personal protective equipment use, reductions in COVID-19 exposure risk, and patient and provider satisfaction.
The goal of this study is to evaluate the implementation of telehealth physical therapy in response to COVID-19 and identify strategies to maintain and scale up its use in a large urban academic medical center. The results indicate that telehealth physical therapy was utilized and accessible during the COVID-19 pandemic, providing guidance for future initiatives to expand its use and study in physical therapy through health policy, quality improvement, and implementation science efforts.
HRSA's Evidence-Based Tele-Emergency Network Grant Program: Multi-site Prospective Cohort Analysis Across Six Rural Emergency Department Telemedicine Networks
Six rural hospital systems received grants from HRSA to study how their emergency telehealth departments affect outcomes for patients. Telehealth was often the patient’s first point of contact and usually resulted in a transfer to a distant hospital or local inpatient facility. Findings suggest that emergency telehealth plays an important role in improving access for rural emergency patients.
A qualitative analysis of nationally-led "Listening and Learning" sessions by the School-Based Health Alliance revealed substantial innovation and expansion of telehealth services due to COVID-10. School-based health programs were shown to reduce barriers to health care access, protect the most vulnerable, and decrease the spread of disease. Telehealth implementations in schools may also help keep youth from emergency departments and provide needed mental health care.
The Provision of Counseling to Patients Receiving Medications for Opioid Use Disorder: Telehealth Innovations and Challenges in the Age of COVID-19
Medications for opioid use disorders (MOUD) combined with behavioral health therapy is an effective approach for the treatment of patients with a substance use disorder (SUD). During the COVID-19 pandemic, the government enacted waivers that allowed behavioral health care for SUD, including prescribing and refilling MOUD to be delivered virtually. This article reviews how these changes have impacted access and describes the need to identify models for hybrid care of patients with SUD in the future.
Patient Characteristics Associated With Telemedicine Access for Primary and Specialty Ambulatory Care During the COVID-19 Pandemic
Telemedicine use has expanded since the onset of the COVID-19 pandemic, and the purpose of this study was to evaluate what inequities may exist in its design. Among patients scheduled for primary care and ambulatory telemedicine visits, differences were seen in rates of telemedicine and video use.
The Maternal Telehealth Access Project (MTAP) was launched to ensure that quality telehealth prenatal and postpartum services are accessible and available in underserved communities during the COVID-19 public health emergency. Increased access to perinatal services and support via telehealth, including clinical care, care coordination, support, and doulas/community health workers leads to improved clinical outcomes for moms and babies.
Telebehavioral Health Use Among Rural Medicaid Beneficiaries: Relationships with Telehealth Policies
This study examines Medicaid telehealth policies and telebehavioral health use among rural fee-for-service (FFS) patients. It finds that rural Medicaid FFS beneficiaries may have better access to telebehavioral health services when they give informed consent in a provider setting.
The expansion of telehealth in Maine is partly driven by Medicare patients. This research suggests telehealth is improving access to behavioral health and speech-language pathology. Telehealth is limited, however, by access problems including provider shortages, lack of broadband, and other insurance coverage like Medicare and commercial policies.
Leveraging Digital Platforms to Scale Health Care Workforce Development: The Career 911 Massive Open Online Course
A massive open online course (MOOC) called Career 911 was created to encourage students from diverse backgrounds to explore health-related professions.
Telepsychiatric Consultation as a Training and Workforce Development Strategy for Rural Primary Care
There is a shortage of rural primary care personnel with expertise in team care for patients with common mental disorders. This research investigated the feasibility of regular systematic case reviews through telepsychiatric consultation, within collaborative care for depression, as a continuous training and workforce development strategy in rural clinics.
Averted Transfers in Rural Emergency Departments Using Telemedicine: Rates and Costs Across Six TeleED Networks
Using telemedicine in rural emergency departments saved an average of $2,673 per patient by avoiding transport costs. The majority of the cost savings went to public insurance.
In response to the COVID-19 public health emergency, health systems needed to quickly transition from in-person visits to telehealth. This study examines the unique challenges within adolescent medicine during this transition, such as patient confidentiality during digital communication and multidisciplinary care teams learning to use video formats.
A telehealth lifestyle intervention to reduce excess gestational weight gain in pregnant women with overweight or obesity (GLOW): a randomised, parallel-group, controlled trial
Significant weight gain in pregnancy among overweight or obese women increases their already elevated risk of having gestational diabetes, a cesarean delivery, and post-partum weight retention. It also increases the chances of a larger infant and the child's risk of obesity. This research investigated whether a telehealth lifestyle intervention reduced excess weight gain in participants.
Process of Identifying Measures and Data Elements for the HRSA School-Based Telehealth Network Grant Program
An analysis of the School-Based Telehealth Network Grant Program’s initiatives to measure the effect that telehealth has on the quality of healthcare services offered in schools. The project also aimed to identify a common set of measures that could assess school-based telehealth services, utilization, processes, and outcomes.
Project Moxie: Results of a Feasibility Study of a Telehealth Intervention to Increase HIV Testing Among Binary and Nonbinary Transgender Youth
Because transgender youth have low rates of engagement in HIV prevention, Project Moxie tested the feasibility of an intervention that provides home-based HIV self-testing combined with video-chat counseling.
Telehealth with remote blood pressure monitoring compared with standard care for postpartum hypertension
Hypertensive disorders of pregnancy (HDP) affect 10% of the pregnancies in the United States and are the most common reason for postpartum hospital readmissions. This study considers whether postpartum home telehealth with remote blood pressure monitoring could reduce the readmission rates during the first 6 weeks postpartum in women with HDP.
Emergency Department Telemedicine Consults are Associated with Faster Time-to-ECG and Time-to-Fibrinolysis for Myocardial Infarction Patients
Heart attack is a common and deadly event that requires treatment as soon as possible. Telemedicine can improve how quickly heart attacks are diagnosed and treated in rural hospitals.
PrEPTECH: a telehealth-based initiation program for human immunodeficiency virus pre-exposure prophylaxis in young men of color who have sex with men. A pilot study of feasibility.
This pilot study uses a telehealth-based approach to pre-exposure prophylaxis (PrEP) initiation as a solution to barriers such as stigma, cost, adherence concerns, and medical distrust.
Provider-to-Provider Telemedicine Improves Adherence to Sepsis Bundle Care in Community Emergency Departments
Sepsis occurs when an infection reaches the bloodstream and getting care quickly improves the chances of survival. In this study, telemedicine in the emergency department improved the rates of adhering to the sepsis treatment protocol. The timely replacement of fluids and the administration of antibiotics greatly improved sepsis care at rural community hospitals.
Treatment of Opioid Use Disorder in Pregnant Women via Telemedicine: A Nonrandomized Controlled Trial
Increased rates of maternal and infant morbidity and mortality are associated with opioid use disorder (OUD). The use of telehealth for maternal care practices for pregnant and postpartum individuals can improve access to care and telehealth services, while reducing the effects of OUD. However, additional evaluation is required before expanding this health care delivery method.
Emergency Department Telemedicine Consults Decrease Time to Interpret Computed Tomography of the Head in a Multi-Network Cohort
A study of emergency telemedicine (tele-ED) for stroke care in four tele-ED networks. Tele-ED was associated with decreased time to diagnostic imaging interpretation and time to thrombolytic medication.
Severe shortages of behavioral health specialists in rural and underserved areas make placing patients in appropriate facilities difficult. This paper describes two different emergency departments in the Midwest using telemedicine to address behavioral health access and placement for patients in rural and underserved areas. Findings suggest that transfer to in-patient facilities was much higher in both models when using telemedicine.
This study evaluated using remote blood pressure monitoring on postpartum women with hypertension when they leave the hospital. It found that remote monitoring of this type showed high patient compliance, retention, and satisfaction.
School-based telehealth programs can expand health care access to rural and underserved youth by eliminating barriers to access, such as transportation. This article describes characteristics of School-Based Telehealth Centers using technology to add to the access of care beyond onsite providers for underserved communities.
Development of a tailored, telehealth intervention to address chronic pain and heavy drinking among people with HIV infection: integrating perspectives of patients in HIV care
Chronic pain and heavy drinking commonly co-occur and can influence the course of HIV, but there have been no interventions designed to address both conditions among people living with HIV. This study aims to better understand pain symptoms, patterns of alcohol use, treatment experiences, and technology use in order to tailor a telehealth intervention that will address all these conditions.
The Use of and Experiences With Telelactation Among Rural Breastfeeding Mothers: Secondary Analysis of a Randomized Controlled Trial
Telelactation services connecting breastfeeding mothers to lactation consultants increase access to professional breastfeeding support in rural areas. This research shows both high demand for and positive experiences with these telehealth services in an underserved population.
Telehealth and texting intervention to improve HIV care engagement, mental health and substance use outcomes in youth living with HIV: a pilot feasibility and acceptability study protocol
This study aims to evaluate the feasibility, acceptability, and preliminary clinical outcomes of a 12-session telehealth counseling series provided to young adults living with HIV that will include education, motivational enhancement and problem-solving around HIV care, mental health, substance use, and other challenges.
Cell Phone Counseling Improves Retention of Mothers With HIV Infection in Care and Infant HIV Testing in Kisumu, Kenya: A Randomized Controlled Study
This study shows the effectiveness of cell phone counseling to keep pregnant women with HIV in care in Kisumu, Kenya. Phone counseling helps reach and retain pregnant women with HIV infection and postpartum mothers in care. It also improved infant HIV testing and antenatal and postnatal care services.
Randomized Controlled Trial of a Mobile Health Intervention to Promote Retention and Adherence to Preexposure Prophylaxis Among Young People at Risk for Human Immunodeficiency Virus: The EPIC Study
Young people are the least likely to use protection against sexually transmitting HIV. An interactive text-messaging intervention significantly increased the odds of using protection among young individuals at risk for getting HIV.
Regular HIV testing does not often happen in primary care visits. Providers want patients to ask for the test, as opposed to suggesting it themselves. This study finds that using a patient-centered text message campaign may prompt patients to discuss HIV testing with their physicians, thereby increasing HIV testing.
The study evaluates two tele-emergency department programs for pediatric patients with different designs, one general and one specialized. The study shows design choices affect how programs are evaluated and highlights the challenge of creating standard metrics.
The Third National Telemedicine & Telehealth Service Provider Showcase Conference: Advancing Telehealth Partnerships
The “Telemedicine & Telehealth Service Provider Showcase” (SPS) Conference, a national conference established in 2014, is a space for discussion on telehealth and relevant components of the telehealth services industry. Key topics shared in the SPS 2017 Conference include the following and more: development of effective partnerships; using telehealth services as a strategic asset; important reimbursement; direct-to-consumer initiatives; legislative and regulatory issues, and overall takeaways.
Feasibility and acceptability of an online positive affect intervention for those living with comorbid HIV depression
This article presents pilot data of using an online intervention to improve the outlook of people living with both HIV and depression. The intervention was rated well by patients and was shown to be both acceptable and feasible to use.
Implementation Strategies for Telestroke: A Qualitative Study of Telestroke Networks in North Carolina
This study examines the adoption decision process and strategies employed during telestroke network development, implementation, and sustainability.
Telestroke is the use of telemedicine in stroke care. This study identifies community and hospital characteristics associated with adoption of telestroke among acute care hospitals in North Carolina.
Patients and caregivers were willing and able to use a mobile program to monitor wounds after surgery. Early results showed health providers identified and managed wound complications.
A Mobile Application for Monitoring and Management of Depressed Mood in a Vulnerable Pregnant Population
This study tested whether a mood tracking and alert mobile application (MTA app) improved mental health care in high-risk pregnant mothers. The MTA app monitored activity, mood, and alerted providers to signs of worsening symptoms. Women who received a telephone call triggered by an MTA app alert were significantly more likely to receive a mental health specialist referral.
Telemedicine Use Decreases Rural Emergency Department Length of Stay for Transferred North Dakota Trauma Patients
Emergency department telemedicine consults for trauma patients were associated with faster hospital transfers and the increased use of radiography.
Telemedicine in behavioral health may improve access to services amidst the critical shortage of mental health professionals. This article reviews the research literature to assess how successful, feasible and cost-effective the use of telemedicine may be in the treatment of mental disorders.