Annotated Bibliography

Original Research Question: Did implementing remote and virtual front desk services, including live representatives via webcam, impact staffing efficiency for underserved patients, especially patients with English as their second language in FQHCs post-pandemic?

Revised Research Question: Did implementing telehealth improve staffing efficiency and delivery of care to underserved populations in FQHCs post-pandemic?

Auchus, I., Jaradeh, K., Tang, A., Marzan, J., & Boslett, B. (2021). Transitioning to Telehealth during the COVID-19 Pandemic: Patient Perspectives and Attendance at an HIV Clinic in San Francisco. AIDS patient care and STDs, 35(7), 249-254. https://doi.org/10.1089/apc.2021.0075.

This study investigated the effect of telehealth models of care on the appointment non-attendance rates of vulnerable HIV-infected patients at a wellness center in San Francisco, California during and after the Covid19 pandemic. The authors compared appointment non-attendance rates before and after March 2020, when the government instituted the shelter-in-place order. The study findings showed a 3 percent decrease in appointment non-attendance rates, with surveyed patients mostly citing safety and convenience as the primary strengths of telehealth. 80.5 percent of surveyed patients reported that telehealth improved access to, and delivery of care, although greater benefits for underserved patient populations would be realized through increased patient education to address technical barriers. The study findings support the idea that telehealth models improve delivery of care to underserved populations by reducing the risk of missed appointments.

Bagchi, A.D., Damas, K., Noguera, N.S., Melamed, B., Menifield, C., Baveja, A., Weber, P., & Swaminathan, S. (2022). Comfort with telehealth among residents of an underserved urban area. Journal of Primary Care & Community Health, 13(1), 1-9.

The above study sought to determine the barriers that low-income African-Americans in New Jerseys Newark face in accessing telehealth. The authors compared telehealth usage rates before and after the implementation of Covid19 social distancing policies. The study was occasioned by the lack of improvement in telehealth uptake rates among this population despite the governments efforts to eliminate regulatory barriers. The study findings showed that the uptake of telehealth was influenced by a patients comfort with telehealth, which was, in turn, influenced by access to basic technologies. Over 80 percent of surveyed residents had access to internet at home, a smartphone, and broadband. However, slightly over 30 percent had not used telehealth, citing low health illiteracy and education levels around teleconferencing. Thus, the study concludes that telehealth has the potential to improve delivery of care to underserved populations, but there is a need to increase the targeted populations comfort with telehealth through educational programs.

Butzner, M., & Cuffee, Y. (2021). Telehealth interventions and outcomes across rural communities in the United States: Narrative review. Journal of Medical Internet Research, 23(8), 1-9.

The authors in this study investigated the outcomes and application of telehealth interventions among underserved rural communities in the US. They reviewed 15 studies, which investigated the outcomes of telehealth interventions for healthcare workers and patients. The authors used annual provider remuneration costs as a proxy for staffing efficiency. They compared costs between hospitals that implemented a telehealth backup model for their ED physicians against those that did not implement a telehealth model. The study found that hospitals that used telehealth reported decreasing remuneration costs over time, while those that did not apply telehealth reported continually increasing costs. More specifically, hospitals that implemented telehealth reported a decrease in costs of $117,406 over a two-year period, whereas those that did not implement telehealth reported an increase in costs of $137,965.

Cottrell, M., Burns, C., Jones, A., Rahmann, A., Young, A., Sam, S., Cruickshank, M., & Pateman, K. (2021). Sustaining allied health telehealth services beyond the rapid...…adopted telehealth in response to Covid19 and continued to use audio-only and video visits. Older patients with limited digital literacy were the greatest beneficiaries of audio-only visits. However, to increase uptake among these populations, the authors recommend integrating professional interpretation services into telehealth models.

Potter, A. J., Muller, P. A., MacKinney, A., & Ward, M. (2014). Effect of tele-emergency services on recruitment and retention of US rural physicians. Rural and Remote Health, 14(3), 2787-2792.

This study investigated the impact of telehealth on recruitment and retention of physicians in 87 rural hospitals in the US. While it was carried out before the Covid19 pandemic, the study provides a means to measure staffing efficiency resulting from implementation of telehealth by means of cost savings from reduced staff turnover. Higher rates of employee retention would translate to reduce turnover costs and high staffing efficiency levels. The study findings showed a positive correlation between telehealth and physician retention. They conclude that telehealth improved physician confidence, eased the burdens associated with face-to-face consultations, and provided educational opportunities, all of which impacted physician retention in rural facilities. Thus, the study findings support the idea that telehealth models would improve staffing efficiency in healthcare organizations within disadvantaged settings, which would, ultimately, improve the delivery of care.

Zhao, M., Hamadi, H., Xu, J., Haley, D., Park, S., & White-Williams, C. (2020). Telehealth and hospital performance: Does it matter? Journal of Telemedicine and Telecare, 1(1), 1-11.

This article provides a means to assess the effect of telehealth on efficiency and cost-reduction using a sample of 2,699 hospitals across the US. The study findings showed a positive correlation between telehealth coverage and efficiency. The authors found that effective implementation of telehealth reduced Medicare per-beneficiary spending, and improved communication among patients and staff, while increasing staffs responsiveness. Hospitals with more…