Browsing by Subject "telehealth"

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    ItemOpen Access
    Gender-Affirming Telepsychology During and After the COVID-19 Pandemic: Recommendations for Adult Transgender and Gender Diverse Populations.
    (Journal of health service psychology, 2021-01) Pankey, Tyson L; Heredia, Dagoberto; Vencill, Jennifer A; Gonzalez, Cesar A
    The implementation of telepsychology soared in response to the 2019 novel coronavirus (COVID-19) pandemic. For most health service psychologists, this surge preceded formal training in telepsychology. Transgender and gender diverse (TGD) individuals reported significant vulnerabilities and health disparities during the COVID-19 pandemic. To ensure the health and well-being of adult transgender and gender diverse individuals during the COVD-19 pandemic and beyond, it is critical to promote the delivery of gender-affirming telepsychology. This article highlights clinical issues observed by health service psychologists at a high-volume gender clinic during the COVID-19 pandemic. The authors provide anticipatory guidance and recommendations to promote gender-affirming telepsychology.
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    Lessons Learned from the Development and Implementation of Virtual and Telehealth Interprofessional Educational Clinics.
    (Advances in medical education and practice, 2021-01) Leiman, Erin R; Waite, Kathleen A; Ostrovsky, Daniel A

    Purpose

    The Interprofessional Educational (IPE) Clinic at Duke is a clinical experience that has allowed an interprofessional team, including health professions students, to care for patients in the emergency department (ED) since 2015. COVID-19 presented fundamental challenges to the structure of this experience, such as student restrictions on attending clinical experiences and limitations on the number of providers in a patient room, which necessitated a transition from face-to-face encounters to virtual ones.

    Materials and methods

    As a result, two virtual experiences were implemented; one was based in the ED with in-person faculty and patients with virtual learners and one staffed by ambulatory providers engaging in telehealth clinics. These experiences sought to provide an interprofessional clinical experience for students while following appropriate safety guidelines. Surveys were distributed to students post-clinic to gather student demographics and their feedback regarding the experience. Additionally, faculty preceptors provided insight into the experience, especially regarding logistics and infrastructure.

    Results

    The virtual experiences successfully allowed teams of students to participate remotely in aspects of care including history taking, physical assessments, and medical decision-making. Additionally, the virtual care team structure allowed for senior students to mentor junior learners and for faculty members to provide point of care feedback. Students gained practical experience in telehealth that included logistics and challenges of providing virtual care and appreciating how technological barriers such as lack of access to internet-connected devices can be a source of disparity.

    Conclusion

    The COVID-19 pandemic required the reconfiguration of an in-person clinical experience to a virtual experience and this pivot was well received by students and faculty. The lessons learned can be generalizable to other professional schools who may be seeking to develop an interprofessional clinical experience and are exploring telehealth options.
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    Optimizing the Equitable Deployment of Virtual Care for Women: Protocol for a Qualitative Evidence Synthesis Examining Patient and Provider Perspectives Supplemented with Primary Qualitative Data.
    (Health equity, 2023-01) Goldstein, Karen M; Patel, Dhara B; Van Loon, Katherine A; Shapiro, Abigail; Rushton, Sharron; Lewinski, Allison A; Lanford, Tiera J; Cantrell, Sarah; Zullig, Leah L; Wilson, Sarah M; Shepherd-Banigan, Megan; Alton Dailey, Susan; Sims, Catherine; Robinson, Cheryl; Chawla, Neetu; Bosworth, Hayden B; Hamilton, Alison; Naylor, Jennifer; Gierisch, Jennifer M

    Introduction

    Women experience numerous barriers to patient-centered health care (e.g., lack of continuity). Such barriers are amplified for women from marginalized communities. Virtual care may improve equitable access. We are conducting a partner-engaged, qualitative evidence synthesis (QES) of patients' and providers' experiences with virtual health care delivery for women.

    Methods

    We use a best-fit framework approach informed by the Non-adoption, Abandonment, Scale-up, Spread, and Sustainability framework and Public Health Critical Race Praxis. We will supplement published literature with qualitative interviews with women from underrepresented communities and their health care providers. We will engage patients and other contributors through multiple participatory methods.

    Results

    Our search identified 5525 articles published from 2010 to 2022. Sixty were eligible, of which 42 focused on women and 24 on provider experiences. Data abstraction and analysis are ongoing.

    Discussion

    This work offers four key innovations to advance health equity: (1) conceptual foundation rooted in an antiracist action-oriented praxis; (2) worked example of centering QES on marginalized communities; (3) supplementing QES with primary qualitative information with populations historically marginalized in the health care system; and (4) participatory approaches that foster longitudinal partnered engagement.

    Health equity implications

    Our approach to exploring virtual health care for women demonstrates an antiracist praxis to inform knowledge generation. In doing so, we aim to generate findings that can guide health care systems in the equitable deployment of comprehensive virtual care for women.
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    Store-and-Forward Images in Teledermatology: Narrative Literature Review.
    (JMIR dermatology, 2022-07-18) Jiang, Simon W; Flynn, Michael Seth; Kwock, Jeffery T; Nicholas, Matilda W

    Background

    Store-and-forward (SAF) teledermatology uses electronically stored information, including patient photographs and demographic information, for clinical decision-making asynchronous to the patient encounter. The integration of SAF teledermatology into clinical practice has been increasing in recent years, especially during the COVID-19 pandemic. Despite this growth, data regarding the outcomes of SAF teledermatology are limited. A key distinction among current literature involves comparing the quality and utility of images obtained by patients and trained clinicians, as these metrics may vary by the clinical expertise of the photographer.

    Objective

    This narrative literature review aimed to characterize the outcomes of SAF teledermatology through the lens of patient- versus clinician-initiated photography and highlight important future directions for and challenges of the field.

    Methods

    A literature search of peer-reviewed research was performed between February and April 2021. Key search terms included patient-initiated, patient-submitted, clinician-initiated, clinician-submitted, store-and-forward, asynchronous, remote, image, photograph, and teledermatology. Only studies published after 2001 in English were included. In total, 47 studies were identified from the PubMed electronic database and Google Scholar after omitting duplicate articles.

    Results

    Image quality and diagnostic concordance are generally lower and more variable with patient-submitted images, which may impact their decision-making utility. SAF teledermatology can improve the efficiency of and access to care when photographs are taken by either clinicians or patients. The clinical outcomes of clinician-submitted images are comparable to those of in-person visits in the few studies that have investigated these outcomes. Coinciding with the onset of the COVID-19 pandemic, asynchronous teledermatology helped minimize unnecessary in-person visits in the outpatient setting, as many uncomplicated conditions could be adequately managed remotely via images captured by patients and referring clinicians. For the inpatient setting, SAF teledermatology minimized unnecessary contact during dermatology consultations, although current studies are limited by the heterogeneity of their outcomes.

    Conclusions

    In general, photographs taken by trained clinicians are higher quality and have better and more relevant diagnostic and clinical outcomes. SAF teledermatology helped clinicians avoid unnecessary physical contact with patients in the outpatient and inpatient settings during the COVID-19 pandemic. Asynchronous teledermatology will likely play a greater role in the future as SAF images become integrated into synchronous teledermatology workflows. However, the obstacles summarized in this review should be addressed before its widespread implementation into clinical practice.
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    Telemedicine utilization by North Carolina farmworkers: a content analysis
    (2023-04-19) Bey, Nadia
    Farmworkers face a variety of barriers to accessing health care. Telehealth, often proposed as a solution to access issues, has yet to be widely adopted by this population due to a lack of broadband access amidst other barriers. Policies surrounding funding for broadband and telehealth reimbursement exacerbate the issue. An examination of public use data shows that farmworkers have a great need for mental health and chronic disease services, and that telehealth may be a useful intervention for both. Pre-existing programs in North Carolina such as the Internet Connectivity Project and TeleFuturo contribute to increasing access. Lessons from these programs show that a variety of public and private funding sources are needed to ensure access to telemedicine for North Carolina farmworkers. It is recommended that policymakers (a) develop incentives for nongovernmental entities to partake in the expansion of broadband connectivity and telehealth programs, (b) require health insurance companies to provide reimbursement parity for all appointment modalities, and (c) require future migrant housing to have internet access. There is also a need to increase the availability of Spanish-language telehealth services.