Rural telemedicine use before and during the COVID-19 pandemic: A repeated cross-sectional study.
Ontology highlight
ABSTRACT: Background
The COVID-19 pandemic has led to a notable increase in telemedicine adoption. Its impact on telemedicine utilization at a population level in rural and remote settings remains unclear.Objective
We aim to evaluate changes in the rate of telemedicine use among rural populations and identify patient characteristics associated with telemedicine use, prior to and during the pandemic.Methods
We conducted a repeated cross-sectional study on all rural telemedicine visits monthly and quarterly from January 2012 to June 2020 using administrative data from Ontario, Canada. We compared changes in utilization for residents of rural and urban regions of the province prior to and during the pandemic.Results
Before the pandemic, telemedicine utilization was steadily low between 2012-2019 for both rural and urban populations, but slightly higher overall for rural patients (11 visits per 1000 rural patients versus 7 visits per 1000 urban patients in December 2019). The rate of telemedicine visits among rural patients significantly increased to 147 visits per 1000 in June 2020. A similar but steeper increase was seen among urban patients (220 visits per 1000). The increase in use was prevalent across various age groups, with the highest rates reported in older adults aged 65 and above (77 visits per 100 patients in 2020). The proportions of patients with at least one telemedicine visit were similar across age groups in 2020 (28.3% for ages 18-49; 27.3% for ages 50-64; and 27.8% for ages 65-79). There were more female users than male users of telemedicine (54.6% vs 45.4% in 2020). There was a significantly higher proportion of telemedicine users residing in comparatively less rural than more rural regions (90.2% vs 9.8% in 2020).Conclusions
Telemedicine adoption grew in rural and remote areas during the COVID-19 pandemic, but higher growth in utilization was seen in urban and less rural populations. Future research on the potential barriers to telemedicine among rural patients and the impact of rural telemedicine on patient healthcare utilization and outcomes is warranted.Clinicaltrial
SUBMITTER: Chu C
PROVIDER: S-EPMC8023379 | biostudies-literature |
REPOSITORIES: biostudies-literature
Similar Datasets
Project description:BackgroundThe coronavirus disease 2019 (COVID-19) pandemic is thought to have increased use of virtual care, but population-based studies are lacking. We aimed to assess the uptake of virtual care during the COVID-19 pandemic using comprehensive population-based data from Ontario.MethodsThis was a repeated cross-sectional study design. We used administrative data to evaluate changes in in-person and virtual visits among all residents of Ontario before (2012-2019) and during (January-August 2020) the COVID-19 pandemic. We included all patients who had an ambulatory care visit in Ontario. We excluded claims for patients who were not Ontario residents or had an invalid or missing health card number. We compared monthly or quarterly virtual care use across age groups, neighbourhood income quintiles and chronic disease subgroups. We also examined physician characteristics that may have been associated with virtual care use.ResultsAmong all residents of Ontario (population 14.6 million), virtual care increased from 1.6% of total ambulatory visits in the second quarter of 2019 to 70.6% in the second quarter of 2020. The proportion of physicians who provided 1 or more virtual visits per year increased from 7.0% in the second quarter of 2019 to 85.9% in the second quarter of 2020. The proportion of Ontarians who had a virtual visit increased from 1.3% in 2019 to 29.2% in 2020. Older patients were the highest users of virtual care. The proportion of total virtual visits that were provided to patients residing in rural areas (v. urban areas) declined significantly between 2012 and 2020, reflecting a shift in virtual care to a service increasingly used in urban centres. The rates of virtual care use increased similarly across all conditions and across all income quintiles.InterpretationOur findings show that Ontario's approach to virtual care led to broad adoption across all provider groups, patient age, types of chronic diseases and neighborhood income. These findings have policy implications, including use of virtual care billing codes, for the ongoing use of virtual care during the second wave of the pandemic and beyond.
| S-EPMC8034297 | biostudies-literature
Project description:ObjectivesIn the context of the ongoing coronavirus disease pandemic in Canada, we aimed to (1) characterize trends in cannabis use in the overall population; and (2) characterize patterns of and identify risk characteristics associated with an increase in cannabis use among those who used cannabis.MethodsData were obtained from three waves of an online, repeated cross-sectional survey of adults residing in Canada (May 08-June 23, 2020; N = 3012). Trends were assessed using Cochran-Armitage and chi-square tests, and risk characteristics were identified using logistic regression analyses.ResultsCannabis use in the overall population remained stable during the months of May and June. Among those who used cannabis, about half increased their cannabis use compared to before the start of the pandemic. This proportion of an increase in cannabis use among those who used cannabis remained consistent across the survey waves. Risk characteristics associated with higher odds of an increase in cannabis use included residence in the central region (Odds ratio, 95% confidence intervals: 1.93, 1.03-3.62), being 18 to 29 years old (2.61, 1.32-5.17) or 30 to 49 years old (1.85, 1.07-3.19), having less than college or university education (1.86, 1.13-3.06) and being somewhat worried about the pandemic's impact on personal finances (1.73, 1.00-3.00).ConclusionsA large proportion of those who used cannabis have increased cannabis use during the pandemic, suggesting a need for interventions to limit increased cannabis use, policy measures to address cannabis-attributable harms, and continued monitoring of cannabis use during and after the pandemic.
| S-EPMC8562922 | biostudies-literature
Project description:BackgroundThe term "telemedicine" refers to the use of communication technology to deliver health care remotely. The COVID-19 pandemic had substantial impacts on health care delivery from 2020 onward, and it was necessary to adapt high-quality care in a manner that limited the potential for viral exposure of both patients and health care workers. Physicians employed video, phone, and electronic written (e-consultation) visits, all of which provided quality of care comparable to that of face-to-face visits while reducing barriers of adopting telemedicine.ObjectiveThis study sought to assess physicians' perspectives and attitudes regarding the use of telemedicine in Riyadh hospitals during the COVID-19 pandemic. The main objects of assessment were as follows: (1) physicians' experience using telemedicine, (2) physicians' willingness to use telemedicine in the future, (3) physicians' perceptions of patient experiences, and (4) the influence of telemedicine on burnout.MethodsThis study employed SurveyMonkey to develop and distribute an anonymous 28-question cross-sectional survey among physicians across all specialty disciplines in Riyadh hospitals. A chi-square test was used to determine the level of association between variables, with significance set to P<.05.ResultsThe survey was distributed among 500 physicians who experienced telemedicine between October 2021 and December 2021. A total of 362 doctors were included, of whom 28.7% (n=104) were consultants, 30.4% (n=110) were specialists, and 40.9% (n=148) were residents. Male doctors formed the majority 56.1% (n=203), and female doctors accounted for 43.9% (n=159). Overall, 34% (n=228) agreed or somewhat agreed that the "quality of care during telemedicine is comparable with that of face-to-face visits." Approximately 70% (n=254) believed that telemedicine consultation is cost-effective. Regarding burnout, 4.1% (n=15), 7.5% (n=27), and 27.3% (n=99) of the doctors reported feeling burnout every day, a few times a week, and a few times per month, respectively.ConclusionsThe physicians had generally favorable attitudes toward telemedicine, believing that its quality of health care delivery is comparable to that of in-person care. However, further research is necessary to determine how physicians' attitudes toward telemedicine have changed since the pandemic and how this virtual technology can be used to improve physicians' professional and personal well-being.
| S-EPMC9278404 | biostudies-literature
Project description:BackgroundTo mitigate the effect of the COVID-19 pandemic, health care systems worldwide have implemented telemedicine technologies to respond to the growing need for health care services during these unprecedented times. In the United Arab Emirates, video and audio consultations have been implemented to deliver health services during the pandemic.ObjectiveThis study aimed to evaluate whether differences exist in physicians' attitudes and perceptions of video and audio consultations when delivering telemedicine services during the COVID-19 pandemic.MethodsThis survey was conducted on a cohort of 880 physicians from outpatient facilities in Abu Dhabi, which delivered telemedicine services during the COVID-19 pandemic between November and December 2020. In total, 623 physicians responded (response rate=70.8%). The survey included a 5-point Likert scale to measure physician's attitudes and perceptions of video and audio consultations with reference to the quality of the clinical consultation and the professional productivity. Descriptive statistics were used to describe physicians' sociodemographic characteristics (age, sex, designation, clinical specialty, duration of practice, and previous experience with telemedicine) and telemedicine modality (video vs audio consultations). Regression models were used to assess the association between telemedicine modality and physicians' characteristics with the perceived outcomes of the web-based consultation.ResultsCompared to audio consultations, video consultations were significantly associated with physicians' confidence toward managing acute consultations (odds ratio [OR] 1.62, 95% CI 1.2-2.21; P=.002) and an increased ability to provide patient education during the web-based consultation (OR 2.21, 95% CI 1.04-4.33; P=.04). There was no significant difference in physicians' confidence toward managing long-term and follow-up consultations through video or audio consultations (OR 1.35, 95% CI 0.88-2.08; P=.17). Video consultations were less likely to be associated with a reduced overall consultation time (OR 0.69, 95% CI 0.51-0.93; P=.02) and reduced time for patient note-taking compared to face-to-face visits (OR 0.48, 95% CI 0.36-0.65; P<.001). Previous experience with telemedicine was significantly associated with a lower perceived risk of misdiagnosis (OR 0.46, 95% CI 0.3-0.71; P<.001) and an enhanced physician-patient rapport (OR 2.49, 95% CI 1.26-4.9; P=.008).ConclusionsThese results indicate that video consultations should be adopted frequently in the new remote clinical consultations. Previous experience with telemedicine was associated with a 2-fold confidence in treating acute conditions, less than a half of the perceived risk of misdiagnosis, and an increased ability to provide patients with health education and enhance the physician-patient rapport. Additionally, these results show that audio consultations are equivalent to video consultations in providing remote follow-up care to patients with chronic conditions. These findings may be beneficial to policymakers of e-health programs in low- and middle-income countries, where audio consultations may significantly increase access to geographically remote health services.
| S-EPMC8171285 | biostudies-literature
Project description:BackgroundThe use of telemedicine outpatient visits has increased dramatically during the COVID-19 pandemic in many countries. Although disparities in access to telemedicine by age and socioeconomic status (SES) have been well-documented, evidence is limited as to how these disparities changed during the COVID-19 pandemic. Moreover, the equity of patient access to telemedicine has been scarcely reported in Japan, despite the huge potential for telemedicine expansion.ObjectiveWe aimed to investigate changes due to age and SES disparities in telemedicine use during the COVID-19 pandemic in Japan.MethodsUsing data from a large internet survey conducted between August 25 and September 30, 2020, in Japan, we examined the associations of participant age and SES (educational attainment, urbanicity of residence, and income level) with their telemedicine use in the following two time periods during the pandemic: April 2020 and August-September 2020.ResultsOf the 24,526 participants aged 18 to 79 years (50.8% [n=12,446] women), the proportion of individuals who reported using telemedicine increased from 2.0% (n=497) in April 2020 to 4.7% (n=1159) in August-September 2020. After adjusting for potential confounders, younger individuals were more likely to use telemedicine than older individuals in April 2020. Although this pattern persisted in August-September 2020, we also observed a substantial increase in telemedicine use among individuals aged 70 to 79 years (adjusted rates, 0.2% in April 2020 vs 3.8% in August-September 2020; P<.001 after multiple comparisons). We found disparities in telemedicine use by SES in August-September 2020 that did not exist in April 2020. In August-September 2020, individuals with a university degree were more likely to use telemedicine than those with a high school diploma or less (adjusted rates, 6.6% vs 3.5%; P<.001). Individuals living in urban areas exhibited higher rates of telemedicine use than those living in rural areas only in August-September 2020 (adjusted rates, 5.2% vs 3.8%; P<.001). Disparities in telemedicine use by income level were not observed in either time period.ConclusionsIn general, younger individuals increased their use of telemedicine compared to older individuals during the pandemic, although individuals in their 70s also increased their use of telemedicine. Disparities in telemedicine use by educational attainment and urbanicity of residence widened during the COVID-19 pandemic.
| S-EPMC8315162 | biostudies-literature
Project description:BackgroundIn the wake of the coronavirus disease 2019 (COVID-19) pandemic, administrative barriers to the use of telemedicine have been reduced in Germany. The study focused on the analysis of use and assessment of telemedicine by physicians working in the outpatient sector, considering the perspective of different disciplines during the COVID-19 pandemic in Germany.MethodsThe anonymous cross-sectional online survey within the study COVID-GAMS was conducted from 16 November 2020 to 1 January 2021. General practitioners; cardiologists; gastroenterologists; paediatricians; gynaecologists; ear, nose, and throat (ENT) specialists were randomly selected and invited to participate in the survey. At the same time, open recruitment to the online survey was conducted via the professional societies. Descriptive and regression analyses were performed based on the data of 1521 outpatient responding physicians.ResultsThe use of telephone and video consultation increased during the pandemic. Regarding the frequency of use, physicians already using telephone/video consultations in March/April 2020 report an increase in such services. General medicine was associated with an increased use of telephone and video consultations than cardiology, gynaecology or ENT, and in the case of telephone consultations also compared to paediatrics. General practitioners assessed the subjective usefulness higher than gynaecology and ENT. And the self-reported proportion of patients receiving telemedical care was higher correlated with general medicine than all other disciplines. The location of the practice (rural vs. urban), type of practice (individual vs. group) and gender (male vs. female) were also shown to be significant influencing factors on the variables mentioned above. Barriers reported by physicians not using telemedicine were the lack of equivalence to face-to-face contact and perceived low demand from patients.ConclusionThe COVID-19 pandemic has led to a significant increase in the use of telemedicine, to varying degrees in the different specialities. Individual and structural factors lead to a reduced use of telemedicine and there are physician's and patient's barriers that have prevented telephone and video consultations from gaining acceptance by physicians. All these factors must be addressed if telemedicine procedures are to be implemented widely.
| S-EPMC9034069 | biostudies-literature
Project description:ObjectivesTo assess the psychometric properties of the Coronavirus Information Overload scale (CovIO) and explore relationships between CovIO, its predictors and several health behaviours related to the COVID-19 pandemic, using Cancer Information Overload (CIO) scale results as a reference for comparison.Methods2003 participants representative of the French adult population answered a self-administered questionnaire over two waves of polling (N1(June 2020)= 1003, N2(January 2021)= 1000). Respondents were randomized to fill CovIO or CIO scale. Psychometric properties of scales were evaluated with Confirmatory Factor Analysis (CFA). Predictors were assessed using multivariate linear regression.ResultsCovIO scale showed satisfactory psychometric properties (α=0.86, ω=0.86, RMSEA=0.050) without any measurement invariance issue. CovIO increased between waves of sampling and was significantly linked to education, health literacy and trust in institutions among other variables. A negative relationship between information overload and preventive behaviours was also observed.ConclusionThe CovIO scale is a valid tool for assessing COVID-19 information overload. The dynamical formation of information overload and links with theorised predictors, especially, health literacy are confirmed.Practice implicationsLongitudinal designs could help better understand the potential detrimental effect of information overload and improving public health campaigns. Interventions to reduce the degree of overload are needed.
| S-EPMC9922676 | biostudies-literature
Project description:The potential impact of the COVID-19 pandemic on young people's mental and physical health is of increasing concern. We examined the levels of internalizing and externalizing problem behavior and physical complaints before and during the COVID-19 pandemic in Germany. Data came from a repeated cross-sectional study on child and youth health in schools in Germany. Assessments took place from November to February each year. Two data collections were conducted before the COVID-19 pandemic in 2018-2019 and in 2019-2020. Collections during the pandemic took place in 2020-2021 and 2021-2022. A total of 63,249 data observations were included in the analyses. Multilevel analyses were used to examine temporal trends in mean emotional problems (e.g., often unhappy, downhearted), hyperactivity-inattention (e.g., constantly fidgeting or squirming), conduct problems (e.g., fights with other children), and physical complaints. Models were adjusted for age, gender, school type, socioeconomic status, and sensation seeking. During the COVID-19 pandemic, children and adolescents in Germany experienced an increase in emotional problems from the pre-pandemic cohort 2019-2020 to the pandemic cohort 2021-2022 (β = 0.56, 95% CI (0.51-0.62)) and, over the course of the pandemic, reported elevated levels of physical complaints (β = 0.19, 95% CI (0.16-0.21)). Findings of increased emotional problems and physical complaints after the two years of the pandemic support the ongoing demand for low-threshold health promotion and prevention and the need for further monitoring of young people's health in Germany.
| S-EPMC10001698 | biostudies-literature
Project description:The critical role of virtual care during the COVID-19 pandemic has raised concerns about the widening disparities to access by vulnerable populations including older immigrants. This paper aims to describe virtual care use in older immigrant populations residing in Ontario, Canada. In this population-based, repeated cross-sectional study, we used linked administrative data to describe virtual care and healthcare utilization among immigrants aged 65 years and older before and during the COVID-19 pandemic. Visits were identified weekly from January 2018 to March 2021 among various older adult immigrant populations. Among older immigrants, over 75% were high users of virtual care (had two or more virtual visits) during the pandemic. Rates of virtual care use was low (weekly average <2 visits per 1000) prior to the pandemic, but increased for both older adult immigrant and non-immigrant populations. At the start of the pandemic, virtual care use was lower among immigrants compared to non-immigrants (weekly average of 77 vs 86 visits per 1000). As the pandemic progressed, the rates between these groups became similar (80 vs 79 visits per 1000). Virtual care use was consistently lower among immigrants in the family class (75 visits per 1000) compared to the economic (82 visits per 1000) or refugee (89 visits per 1000) classes, and was lower among those who only spoke French (69 visits per 1000) or neither French nor English (73 visits per 1000) compared to those who were fluent in English (81 visits per 1000). This study found that use of virtual care was comparable between older immigrants and non-immigrants overall, though there may have been barriers to access for older immigrants early on in the pandemic. However, within older immigrant populations, immigration category and language ability were consistent differentiators in the rates of virtual care use throughout the pandemic.
| S-EPMC10395820 | biostudies-literature
Project description:BackgroundTo characterize various aspects of telemedicine use by pediatric rheumatology providers during the recent pandemic including provider acceptability of telehealth practices, clinical reliability, and clinical appropriateness.MethodsAn electronic survey was generated and disseminated amongst the Childhood Arthritis and Rheumatology Research Alliance (CARRA) listserv (n = 547). Survey items were analyzed via descriptive statistics by question.ResultsThe survey response rate was 40.8% (n = 223) with the majority of respondents in an attending-level role. We observed that musculoskeletal components of the exam were rated as the most reliable components of a telemedicine exam and 86.5% of survey respondents reported engaging the patient or patient caregiver to help conduct the virtual exam. However, 65.7% of providers reported not being able to elicit the information needed from a telemedicine visit to make a complete clinical assessment. We also noted areas of disagreement regarding areas of patient engagement and confidentiality. We found that approximately one-third (35.8%) of those surveyed felt that their level of burnout was increased due to telemedicine.ConclusionIn general, providers found exam reliability (specifically around focused musculoskeletal elements) in telemedicine visits but overall felt that they were unable to generate the information needed to generate a complete clinical assessment. Additionally, there were suggestions that patient engagement and confidentiality varied during telemedicine visits when compared to in-person clinical visits. Further qualitative work is needed to fully explore telemedicine use in pediatric rheumatology.
| S-EPMC8206874 | biostudies-literature