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Importance
Telemedicine is increasingly used to provide outpatient pediatric neurology consultations in underserved communities. Although telemedicine clinics have been shown to improve access, little is known about how they alter patients’ utilization of hospital services.
Objective
To evaluate the association between access to telemedicine clini...
Contexts in source publication
Context 1
... shown in Table 3, the bivariable all-cause and neurologic hospital encounter rates were lower for patients in the telemedicine cohort compared with patients in the in-person cohort (for all-cause encounters, IRR, 0.25; 95% CI, 0.18-0.36; for neurologic encounters, IRR, 0.35; 95% CI, 0.23-0.54). ...Context 2
... encounter rates were inversely associated with the patient's travel time to the neurology clinic (telemedicine or in person), median household income, education level, and completion rate of neurology clinic appointments. Rates of hospital encounters were higher for patients who had nonprivate insurance than for patients who had private insurance (Table 3). ...Citations
... Those savings might be more meaningful in low-income countries with scarce resources and limited transportation options. With lower cost and ease of access, fear of overutilization of telemedicine is a potential concern to drive healthcare cost higher and overwhelm the healthcare system [78]. However, overutilization by underserved populations should not be a primary concern at this stage and can be easily regulated in the future if proven to be true. ...
Objectives
Caring for children in low- and middle-income countries (LMIC) can be challenging. This review article aims to explore role of telemedicine in supporting pediatric care in LMIC.
Methodology
A narrative review of existing English and Spanish literature was conducted to assess role of telemedicine to support pediatric care in LMIC.
Results
Beside medical education and direct pediatric care, telemedicine can provide sub-specialties consultations without extra burden on families. Additionally, telemedicine can help in lowering under-5 mortality by supporting neonatal care, infectious illnesses, and non-communicable diseases (NCDs). Telemedicine can be a gate for universal coverage for all children at a lower cost. For over a decade, it has been implemented successfully and sustained in a few LMIC. However, challenges in implementing telemedicine are enormous. Still, opportunities arise by using simpler technology, low-width band internet, smartphones, instant messaging applications and solar energy. COVID-19 pandemic facilitated acceptance and applicability of telemedicine worldwide including LMIC. Nevertheless, governments must regulate telemedicine by issuing policies and ensuring employment of local experts when possible to meet local resources and cultural competency.
Conclusion
Telemedicine has proven successful in improving pediatrics care. Many LMIC should take advantage of this innovation to promote equity and access to high quality pediatric care.
... Previous studies reported that pediatric subspecialty care delivered via telemedicine was associated with high parental satisfaction and, in some cases, improved health outcomes. [52][53][54][55] Recently, a step-bystep guide was proposed for the provision of remote infectious diseases support for patient consultations and antimicrobial stewardship activities in underserved communities in the United States. 56 ...
Pediatric infectious diseases (PID) physicians prevent and treat childhood infections through clinical care, research, public health, education, antimicrobial stewardship, and infection prevention. This article is part of an American Board of Pediatrics Foundation–sponsored supplement investigating the future of the pediatric subspecialty workforce. The article offers context to findings from a modeling analysis estimating the supply of PID subspecialists in the United States between 2020 and 2040. It provides an overview of children cared for by PID subspecialists, reviews the current state of the PID workforce, and discusses the projected headcount and clinical workforce equivalents of PID subspecialists at the national, census region, and census division levels over this 2-decade period. The article concludes by discussing the education and training, clinical practice, policy, and research implications of the data presented. Adjusting for population growth, the PID workforce is projected to grow more slowly than most other pediatric subspecialties and geographic disparities in access to PID care are expected to worsen. In models considering alternative scenarios, decreases in the number of fellows and time spent in clinical care significantly affect the PID workforce. Notably, model assumptions may not adequately account for potential threats to the PID workforce, including a declining number of fellows entering training and the unknown impact of the COVID-19 pandemic and future emerging infections on workforce attrition. Changes to education and training, clinical care, and policy are needed to ensure the PID workforce can meet the future needs of US children.
... 4,35,44,45,49,50,54,59,68,70 Since a variety of settings are captured under the term ''safety net,'' we also analyzed differences in outcomes by federal designation (FQHC, CHC, RHC, academic, safety net) according to the articles. Of the articles with positive results, n = 7 examined FQHCs, 34,56,62,63,66,67,69 n = 4 CHCs, 31,40,46,67 n = 7 academic settings, 29,39,47,48,60,64,65 and n = 4 safety net settings. 38,42,55,57 The study with null results examined an FQHC. ...
Background: Telemedicine systems were rapidly implemented in response to COVID-19. However, little is known about their effectiveness, acceptability, and sustainability for safety net populations. This study systematically reviewed primary care telemedicine implementation and effectiveness in safety net settings. Methods: We searched PubMed for peer-reviewed articles on telemedicine implementation from 2013 to 2021. The search was done between June and December 2021. Included articles focused on health care organizations that primarily serve low-income and/or rural populations in the United States. We screened 244 articles from an initial search of 343 articles and extracted and analyzed data from N = 45 articles. Results: Nine (20%) of 45 articles were randomized controlled trials. N = 22 reported findings for at least one marginalized group (i.e., racial/ethnic minority, 65 years+, limited English proficiency). Only n = 19 (42%) included African American/Black patients in demographics descriptions, n = 14 (31%) LatinX/Hispanic patients, n = 4 (9%) Asian patients, n = 4 (9%) patients aged 65+ years, and n = 4 (9%) patients with limited English proficiency. Results show telemedicine can provide high-quality primary care that is more accessible and affordable. Fifteen studies assessed barriers and facilitators to telemedicine implementation. Common barriers were billing/administrative workflow disruption (n = 9, 20%), broadband access/quality (n = 5, 11%), and patient preference for in-person care (n = 4, 9%). Facilitators included efficiency gains (n = 6, 13%), patient acceptance (n = 3, 7%), and enhanced access (n = 3, 7%). Conclusions: Telemedicine is an acceptable care modality to deliver primary care in safety net settings. Future studies should compare telemedicine and in-person care quality and test strategies to improve telemedicine implementation in safety net settings.
... A video connection could also be used in combination with patient portals and access to EHRs [42] and different devices and apps [125]. Video consultations offer possibilities for first and follow-up visits at the clinic [46,49,53], for peri-and postoperative sessions [125] and for medication and psychotherapy sessions [59]. ...
... Children with neurologic conditions Dayal et al [49] Patients of a rheumatology clinic used a video connection for clinic visits. The barriers to usage were older age, limited access to technology, and a short distance to the clinic. ...
... There are, however, also studies that concurrently fit into the telediagnosis cluster, offering a possibility to access health care using a video connection and thus enabling an early diagnosis [41,57,129]. The results indicate that the use of video consultations will also continue in the future as they are seen as a compatible and cost-effective way of providing consultation also in medical specialties and with different kinds of tools, such as WhatsApp or Zoom [1,2,46,49,53,67,125]. The use of or the possibility for video consultation is especially important for rural and other areas with long distances, though infrastructural or cultural issues may currently prevent or delay the use of digital services in some locations [67,84,108,119]. ...
Background:
The development of digital health services reflects not only the technical development of services but also a change in attitude and the way of thinking. It has become a cornerstone for engaging and activating patients and citizens in health management while living at home. Digital health services are also aimed at enhancing the efficiency and quality of services, while simultaneously providing services more cost-effectively. In 2020, the COVID-19 pandemic accelerated worldwide the development and use of digital services in response to requirements for social distancing and other regulations.
Objective:
The aim of this review is to identify and summarize how digital health services are being used among patients and citizens while living at home.
Methods:
The Joanna Briggs Institute (JBI) methodology for scoping reviews was used as guidance. A search conducted in 3 databases (CINAHL, PubMed, Scopus) resulted in 419 papers. The reporting was conducted by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping review (PRISMA-ScR), and the analysis of the included papers was performed using a framework consisting of 5 clusters describing the use of digital health services. After screening and excluding papers that did not match the inclusion criteria, 88 (21%) papers from 2010 to 2022 were included in the final analysis.
Results:
Results indicated that digital health services are used in different situations and among different kinds of populations. In most studies, digital health services were used in the form of video visits or consultations. The telephone was also used regularly for consultations. Other services, such as remote monitoring and transmitting of recorded information and the use the of internet or portals for searching information, were observed as well. Alerts, emergency systems, and reminders were observed to offer possibilities of use, for example, among older people. The digital health services also showed to have potential for use in patient education.
Conclusions:
The development of digital services reflects a shift toward the provision of care regardless of time and place. It also reflects a shift toward emphasis on patient-centered care, meaning activating and engaging patients in their own care as they use digital services for various health-related purposes. Despite the development of digital services, many challenges (eg, adequate infrastructure) still prevail worldwide.
... The health literacy factor could explain the relationship between education and hospital utilization. The previous study found that health literacy is related to higher hospital utilization [51], and it mediates educational attainment with the higher benefits from the healthcare setting [52,53]. Individuals with higher healthcare literacies could have more resources (knowledge, communication, and relation) and be more autonomous in choosing healthcare facilities and treatment [54]. ...
Background
The disadvantaged areas are one of the government’s focuses in accelerating development in Indonesia, including the health sector. The study aims to determine the target for expanding hospital utilization in disadvantaged areas in Indonesia.
Methods
The study employed the 2018 Indonesian Basic Health Survey data. This cross-sectional study analyzed 42,644 respondents. The study used nine independent variables: residence, age, gender, marital, education, employment, wealth, insurance, and travel time, in addition to hospital utilization, as a dependent variable. The study employed binary logistic regression to evaluate the data.
Results
The results found that average hospital utilization in disadvantaged areas in Indonesia in 2018 was 3.7%. Urban areas are 1.045 times more likely than rural areas to utilize the hospital (95% CI 1.032–1.058). The study also found age has a relationship with hospital utilization. Females are 1.656 times more likely than males to use the hospital (95% CI 1.639–1.673). Moreover, the study found marital status has a relationship with hospital utilization. The higher the education level, the higher the hospital utilization. Employed individuals have a 0.748 possibility to use the hospital compared with those unemployed (95% CI 0.740–0.757). Wealthy individuals have more chances of using the hospital than poor individuals. Individuals with all insurance types are more likely to utilize the hospital than those uninsured. Individuals with travel times of ≤ 1 h are 2.510 more likely to use the hospital than those with > 1 h (95% CI 2.483–2.537).
Conclusion
The specific targets to accelerate the increase in hospital utilization in disadvantaged areas in Indonesia are living in a rural area, being male, never in a union, having no education, being employed, being the poorest, uninsured, and having a travel time of > 1 h. The government should make a policy addressing the problem based on the research findings.
... The health literacy factor could explain the relationship between education and hospital utilization. The previous study found health literacy is related to higher hospital utilization (52), and it mediates educational attainment with the higher benefits from the healthcare setting (53,54). Individuals with higher healthcare literacies could have more resources (knowledge, communication, relation) and be more autonomous in choosing healthcare facilities and treatment (55). ...
Background: The disadvantaged areas are one of the government's focuses in accelerating development in Indonesia, including the health sector. The study aims to determine the target for expanding hospital utilization in disadvantaged areas in Indonesia. Methods: The study employed the 2018 Indonesian Basic Health Survey data. This cross-sectional study analyzed 42,644 respondents. The study used nine independent variables: residence, age, gender, marital, education, employment, wealth, insurance, and travel time, in addition to hospital utilization, as a dependent variable. The study employed binary logistic regression to evaluate the data. Results: The results found that average hospital utilization in disadvantaged areas in Indonesia in 2018 was 3.7%. Urban areas are 1.045 times more likely than rural areas to utilize the hospital (95% CI 1.032-1.058). The study also found age has a relationship with hospital utilization. Females are 1.656 times more likely than males to use the hospital (95% CI 1.639-1.673). The study also found marital has a connection with hospital utilization. The higher the education level, the higher the hospital utilization. The employed have a possibility of 0.748 compared to the unemployed to use the hospital (95% CI 0.740-0.757). All wealthy status have more chances to use the hospital than the poorest. All insurance types are more likely than uninsured to utilize the hospital. Travel times of ≤1 hour are 2.510 more likely than >1 hour to use the hospital (95% CI 2.483-2.537).
... However, missed appointments often could not be made up in a timely manner. Dayal et al [12] compared an in-person visit cohort with a telemedicine visit cohort in their outpatient pediatric neurology clinic and reported that telemedicine visits were more likely to be completed versus cancelled or missed compared to in-person visits. The authors concluded that telemedicine could serve as an equal supplement to in-person visits. ...
... In developing countries with low incomes and high rural populations, telemedicine could offer, on one hand, opportunities to bring a higher level of health service to patients in isolated regions [12,15], but on the other hand, they might be limited by the supply of hardware and software, as well as by data volume and signal strength; these are issues that should be investigated. ...
Background:
During the COVID-19 pandemic, parents of very preterm and "at risk" born infants were exceptionally worried of being infected. The only mean of protection during the onset of the pandemic was social distancing. Video consultations for neurodevelopmental follow-up care were offered as an alternative way to stay in contact with patients and their families, to provide qualified support and to monitor and assess the child's development.
Objective:
To assess the feasibility of this method and family satisfaction, an interview was conducted after video and an in-person consultation.
Methods:
An interview containing 28 questions was created to evaluate parental satisfaction, for example, confidentiality, children's behavior during consultation. A total of 93 interviews with parents were conducted and compared (58 after a video and 35 after in person consultation). Interviews were conducted at the end of the consultation by a trained professional between March 2020 and February 2021. The video consultation was conducted using the certified platform by Zava Sprechstunde Online GmbH® maintaining data protection by an end-to-end-encryption. Follow-up consultations (via video and in-person) were performed at a corrected age of 3, 6 and 12 months as well as 2, 3, 4 and 5 years. The rate of total follow-up appointments attended during the survey period within the COVID-19 pandemic was evaluated and compared with the previous year.
Results:
There were no significant differences between video and in-person consultation groups in satisfaction, confidentiality of the consultation and discussion of private and sensitive information. Following video consultation, parents shared significantly their avoidance to contact medical professionals more often (P = .045; W = 1094.5, d = -0.1782146, n=93) than the in-person consultation group. Parents of the video consultation group stated that performing a guided examination on their child as comfortable and helpful in understanding their child's development. In fact, they agreed to take advantage of a future video consultation. The rate of total follow-up appointments compared to the previous year's rate even increased. Between March 2019 and February 2020, 782 out of 984 (79.5%) children born at Essen University Hospital attended a follow-up appointment. During the survey period between March 2020 and February 2021, a total of 788 out of 1086 children (73%) attended a follow-up appointment, 14.9% were video consultations.
Conclusions:
The feasibility and parental satisfaction attending video consultation for follow-up care of their very preterm or at risk-born infant was as high as in-person consultation. Parents rated video consultations as confidential as in-person appointments. Telemedicine can be offered as an equivalent alternative to an in-person consultation and is particularly useful under certain circumstances i.e. for very sick children who require assistive devices, e.g. respiratory support and oxygen or for those living long distances.
... Connecting with patients remotely can allow for improved triage and acute visits, reduce missed appointment rates, increase adherence to recommended therapies, and ensure the appropriate frequency of recommended physician visits, all of which can improve disease management. 40,84,85 Additionally, this technology can minimize burdens of parents and other caregivers missing work, children and adolescents missing school, and costs and risks associated with travel. 7,36,[86][87][88] Although advancing technology, including the development of diagnostic equipment that may be employed by the patient or parent under the direction of a remotely located provider, may make remote diagnosis more available in the future, limitations of the remote encounter will likely remain when the provider cannot have hands-on contact with the patient. ...
... However, the increased availability of care services to underresourced populations can serve as an opportunity to provide timely care while reducing costs over the long term. 85 Increased utilization of relatively low-cost primary care services can be the leading indicator for lower overall costs because prevention and early detection are enhanced by more convenient access to primary care. There is the potential for fraud and abuse in any medical care encounter, and payers can use the same protocols for detection and prevention of fraud as are used for in-person care. ...
The use of telehealth technology to connect with patients has expanded significantly over the past several years, particularly in response to the global coronavirus disease 2019 pandemic. This technical report describes the present state of telehealth and its current and potential applications. Telehealth has the potential to transform the way care is delivered to pediatric patients, expanding access to pediatric care across geographic distances, leveraging the pediatric workforce for care delivery, and improving disparities in access to care. However, implementation will require significant efforts to address the digital divide to ensure that telehealth does not inadvertently exacerbate inequities in care. The medical home model will continue to evolve to use telehealth to provide high-quality care for children, particularly for children and youth with special health care needs, in accordance with current and evolving quality standards. Research and metric development are critical for the development of evidence-based best practices and policies in these new models of care. Finally, as pediatric care transitions from traditional fee-for-service payment to alternative payment methods, telehealth offers unique opportunities to establish value-based population health models that are financed in a sustainable manner.
... In addition to the number of available providers, access to pediatric subspecialty care is impacted by the geographic dispersion of subspecialists 9 and care models that incorporate telehealth. [23][24][25] This paper examines one aspect of the supply side of the pediatric subspecialty workforce, the entry of individuals into the first year of fellowship training. We evaluated data from the American Board of Pediatrics (ABP) across multiple years to characterize and quantify recent trends in the number of first-year fellows entering the 14 ABP-certified pediatric medical subspecialties. ...
To inform discussions of pediatric subspecialty workforce adequacy and characterize its pipeline, we examined trends in first-year fellows in the 14 American Board of Pediatrics (ABP)-certified pediatric medical subspecialties, 2001–2018.
Data were obtained from the ABP Certification Management System. We determined, within each subspecialty, the annual number of first-year fellows. We assessed for changes in the population using variables available throughout the study period (gender, medical school location, program region, and program size). We fit linear trendlines and calculated χ² statistics.
The number of first-year pediatric medical subspecialty fellows increased from 751 in 2001 to 1445 in 2018. Fields with the growth of 3 or more fellows per year were Cardiology, Critical Care, Emergency Medicine, Gastroenterology, Neonatology, and Hematology Oncology (P value <0.05 for all). The number of fellows entering Adolescent Medicine, Child Abuse, Infectious Disease, and Nephrology increased at a rate of 0.5 fellows or fewer per year. Female American Medical Graduates represented the largest and growing proportions of several subspecialties. Distribution of programs by region and size were relatively consistent over time, but varied across subspecialties.
The number of pediatricians entering medical subspecialty fellowship training is uneven and patterns of growth differ between subspecialties.
The number of individuals entering fellowship training has increased between 2001 and 2018.
Growth in the number of first-year fellows is uneven.
Fields with the greatest growth: Critical Care, Emergency Medicine, and Neonatology.
Fields with limited growth: Adolescent Medicine, Child Abuse, Infectious Disease, and Nephrology.
Concerns about the pediatric medical subspecialty workforce are not explained by the number of individuals entering the fellowship.
... In addition, telemedicine can be an effective tool to support families in rural areas with difficult traffic connections and less accessible social services. Recently, Dayal et al. 4 proofed in a cross-sectional study that children receiving neurological consultation via telemedicine utilized significantly less high-cost hospital encounters compared to children with in-person neurological consultations. ...
