Annotated Bibliography Telehealth Models

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 Jersey’s 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 government’s efforts to eliminate regulatory barriers. The study findings showed that the uptake of telehealth was influenced by a patient’s 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 response to COVID-19: Learning from patient and staff experiences at a large quaternary hospital. Journal of Telemedicine and Telecare, 27, 615 - 624. https://doi.org/10.1177/1357633X211041517.

The authors in this study sought to understand the experiences and perspectives of clinicians and patients regarding the use of telehealth, particularly teleconferencing. Using a combination of surveys and focus group discussions, and a sample of 66 clinicians and 109 patients; the study found that telehealth yielded positive experiences in the delivery of care to patients. However, both clinicians and patients agree that there is a need to blend telehealth with face-to-face consultation models since not all services could be obtained effectively via telehealth. To enhance the use of telehealth across populations, the study recommends increasing assistance for administrative staff in healthcare facilities, enhancing technical support, and patient/workforce training.

Eastman, P., Dowd, A., White, J., Carter, J., & Ely, M. (2021). Telehealth: rapid adoption in community palliative care due to COVID-19: patient and professional evaluation. BMJ Supportive & Palliative Care. https://doi.org/10.1136/bmjspcare-2021-002987.

This study sought to understand the experiences of both patients and healthcare professionals in using telehealth palliative care services during the Covid19 pandemic. The authors interviewed 22 healthcare professionals and 74 patients at Barwon Health in Australia, which primarily serves disadvantaged families and communities in Geelong. The study findings provide a clear picture of the benefits of telehealth to underserved populations. 72 percent of the patient participants reported that they had used both video conferencing and telephone for their telehealth consultations, while 64 percent reported using telephone alone. 71 percent of the patients agreed that telehealth was able to meet their needs and they did not encounter issues using it. The 29 percent who reported experiencing issues with telehealth reported technological problems, low education levels, and sensory deficits as the primary challenges. A majority of the surveyed patients indicated a preference for face-to-face visits over telehealth models. However, 60 percent reported a preference for a combination of both. The study findings thus provide an interesting idea that maximum health outcomes for underserved populations would be realized through a combination of face-to-face and telehealth models.

Erikson, C., Park, Y., Felida, N., & Dill, M. (2023). Telehealth use and access to care for underserved populations before and during the Covid19 pandemic. Journal of Healthcare for the Poor and Underserved, 34(1), 132-145.

The authors in this study investigated the impact of telehealth uptake on access to care among underserved populations. Using data from the American Medical College Consumers Survey, the study compared telehealth use and access to care among vulnerable populations in 2020 and prior years. The study findings showed that telehealth use before the pandemic was associated with greater access, while use during the pandemic had no effect on access. The authors conclude that this is because telehealth during the pandemic was not a supplement for access to care, but a substitute. However, they insist that in the post-pandemic period, telehealth use would increase access to care for these populations, especially if the policies adopted to promote such use during the pandemic are maintained.

Franciosi, E., Tan, A., Kassamali, B., Leonard, M., Zhou, G., Krueger, S., Rashighi, M., & Lachance, A. (2021). The impact of telehealth implementation on underserved populations and no-show rates by medical specialty during the Covid19 pandemic. Telemedicine Journal and e-health: The official Journal of the American Telemedicine Association. https://doi.org/10.1089/tmj.2020.0525.

This study compared in-person clinic visits at the UMass Memorial Clinic in 2019 with trends in 2020 telehealth visits to identify changes in the demographic characteristics and no-show rates of visiting patients. The study found that televisits reduced the occurrence of no-shows for all racial and ethnic categories, as well across English and ESL (English as Second Language) patients. However, the authors found significant decreases in the number of ESL patients with televisits across all five specialties of primary care (11.2 to 8.7%), adult non-surgical (10.8 to 9.1%), pediatric non-surgical (11.1 to 11%), adult surgical (12.1 to 9.1%), and pediatric surgical (8.6 to 4.2%). In the racial category, whites reported an increase with televisits across all specialties, while all other racial groups reported decreases. The study findings indicate that telehealth reduced the number of non-English and minority patients that were seen at the facility across all specialties. The authors conclude that this is due to the lack of technical skills among underserved populations, and the unavailability of telephone interpreters to cater for ESL patients seeking care through telehealth. Thus, the study shows that telehealth has the potential to improve the delivery of care to ESL patients and other underserved populations, although policymakers would need incorporate creative ways, such as translation services, to meet the needs of such patients.

Payan, D. D., Frehn, J. L., Garcia, L., Tierney, A., & Rodriguez, H, P. (2022). Telemedicine implementation and use in community health centers during Covid19: Clinic personnel and patient perspectives. Qualitative Research in Health, 2(1), 1-9.

The authors in this study sought to obtain the telehealth experiences of patients and personnel in two federally qualified health centers serving Latino and Chinese immigrants in California. The study findings showed that telehealth improved access to healthcare for underserved populations during and after the Covid19 pandemic. Both facilities 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.