Reducing outpatient wait times through telemedicine: a systematic review and quantitative analysis

BMJ Open, Journal Year: 2025, Volume and Issue: 15(1), P. e088153 - e088153

Published: Jan. 1, 2025

Objectives Population ageing and the rise in chronic diseases place continual stress on healthcare systems. Scarce resources often impede equitable access to healthcare, particularly rural areas, resulting prolonged waiting times heightened risks of morbidity mortality. Telemedicine has emerged as a promising solution, offering remote care that could potentially bridge gaps enhance health outcomes. This systematic review aims quantitatively examine impact telemedicine implementation times, defined time passed from booking visit for an outpatient administration service. Design A was conducted using studies interventions specifically addressed times. Bias assessment performed with three tools: ROBINS-I (“Risk In Non-Randomized Studies Interventions”), AXIS ("Appraisal tool Cross-Sectional Studies") RoB-2 ("Risk Bias-2"). weighted mean approach used synthesise results, medians synthesised median approach. Data sources Articles English were retrieved PubMed Scopus databases. Eligibility criteria excluded if they did not address related interventions. Only considered service any intervention included. extraction synthesis total 53 records included, encompassing 270 388 patients both experimental control groups. The reduction calculated, bias assessed. No record evaluated be at high risk bias, 69.8% low 26.4% moderate (3.8% surveys). Results reporting means, medians. Overall, 25.4 days observed. Focusing clinical specialties (n=114 042), amounted 34.7 days, while surgical (n=156 346), associated 17.3 saved. Conclusions solutions may significantly improve leading more efficient PROSPERO registration number CRD42023490822.

Language: Английский

---

Supporting Physical and Mental Health in Rural Veterans Living With Heart Failure: Protocol for a Nurse-Led Telephone Intervention Study

JMIR Research Protocols, Journal Year: 2025, Volume and Issue: 14, P. e63498 - e63498

Published: March 26, 2025

Background Heart failure (HF) remains a disease of notable disparity for rural veterans, despite recent advancements in clinical treatment. Managing HF the home is stressful and complex veterans who experience unique barriers to optimal physical mental health, necessitating adequate support problem-solving skills. Objective This study aims (1) adapt, sociocultural context, culturally sensitive, tailored, telephone intervention (CARE-HF [Supporting Physical Mental Health Rural Veterans With Failure]) using findings from preliminary qualitative research (2) evaluate effects CARE-HF on health outcomes among with HF. Methods involves repeated-measures, single-group design. The content was adapted tailored context data guided by Theories Social Problem-Solving Stress, Appraisal, Coping. are recruited Administration home-based cardiac rehabilitation clinics, cardiology clinics that serve veterans-based community resource centers, social media campaigns. (N=100) receive intervention. nurse-led comprises 8 sessions use five-step, process manage common problems home: identifying problem viewing it positive manner, goal setting, (3) generating potential strategies management, (4) choosing implementing problem, (5) evaluating strategy effectiveness. initial training during first session, follow-up focusing skill reinforcement assisting applying these principles self-identified, HF-related experienced home. Data collected at baseline 3, 6, 12, 18 months interest (ie, self-care; symptoms; care utilization; depressive anxiety; HF-specific, health-related quality life; stress; resilience; coping). Demographic will be analyzed descriptive statistics multilevel growth curve modeling restricted maximum likelihood estimation compare series models Akaike information criteria Bayesian fit indices while controlling covariates. Results Recruitment started April 2023. As December 2024, we have enrolled 56 veterans. anticipated end June 2025, collection continuing until all completed 18-month period. Conclusions Adapting testing aid has provide individualized where they reside, thereby reducing travel burden also increasing access evidence-based programs. If effective, interventions could low-cost, accessible method improve Trial Registration ClinicalTrials.gov NCT05839067; https://clinicaltrials.gov/study/NCT05839067 International Registered Report Identifier (IRRID) DERR1-10.2196/63498

Language: Английский

---

Decarbonizing Health Care: Measuring the Carbon Footprint Impact of a National VA Telehealth Program

NEJM Catalyst, Journal Year: 2025, Volume and Issue: 6(5)

Published: April 16, 2025

Health care systems are increasingly recognizing the environmental harms generated by medical and seeking to reduce their carbon footprints. They can accomplish measurable reductions in greenhouse gas emissions while maintaining high quality even improving pursuing cobenefits - programs that simultaneously harm benefit patients' health. The authors describe Advanced Comprehensive Diabetes Care (ACDC), an evidence-based telehealth program for diabetes patients U.S. Department of Veterans Affairs (VA) system has concurrently improved patient reduced VA's footprint. Designed with poor control, leverages existing clinical infrastructure provide nurse-delivered telemonitoring, self-management support, provider-aided medication management. ACDC outcomes reducing travel time, out-of-pocket costs, emissions. served 576 between 2017 2022. estimate prevented over 200,000 miles driving, saving around US$20,000 gasoline costs 82 metric tons dioxide emission compared equivalent in-person care. provides a template health as well provider satisfaction money producing

Language: Английский

---

Human technology intermediation to reduce cognitive load: understanding healthcare staff members’ practices to facilitate telehealth access in a Federally Qualified Health Center patient population

Journal of the American Medical Informatics Association, Journal Year: 2024, Volume and Issue: 31(4), P. 832 - 845

Published: Jan. 31, 2024

Abstract Objectives The aim of this study was to investigate how healthcare staff intermediaries support Federally Qualified Health Center (FQHC) patients’ access telehealth, their approaches reflect cognitive load theory (CLT) and determine which FQHC patients find helpful whether perceptions suggest (CL) reduction. Materials Methods Semistructured interviews with (n = 9) 22) at an in a Midwestern state. First-cycle coding interview transcripts performed inductively identify helping processes participants’ evaluations them. Next, these inductive codes were mapped onto deductive from CLT. Results Staff used 4 to, usage of, video visits patient portals for patients: (1) shielding overload; (2) drawing long-term memory; (3) supporting the development schemas; (4) reducing extraneous negative emotions. These could contribute CL reduction each viewed as least some patients. For patients, there beneficial impacts on learning, emotions, about self technology. Intermediation also resulted successful despite challenges. Discussion made telehealth work emotional crucial. Without prior training, discovered that aligned CLT helped technologies. Future intermediary interventions may benefit application design. providing brief explanations technical problems solutions might help learn technologies informally over time. Conclusion can developing facilitating access.

Language: Английский

---

Will the United States pass on telemedicine progress?

JAMIA Open, Journal Year: 2024, Volume and Issue: 7(1)

Published: Jan. 4, 2024

Abstract Background During the COVID-19 pandemic, federal and state health policies allowed temporary flexibilities for Medicare Medicaid beneficiaries, leading to a sharp increase in telemedicine use. However, many of that enabled innovation growth continue temporarily since emergency declaration ended May 2023, United States has not made permanent decisions about policy. Analysts have raised concerns increased spending, program integrity, safety, equity, recommend strengthening oversight. Methods Here, we argue must better understand telemedicine’s quality, outcomes, until can develop an evidence-based digital strategy. A premature regression pre-pandemic risks unintended consequences. Conclusion We current policy flexibilities, safeguard against fraud abuse, immediately prioritize research evaluation avoid consequences support more decision-making.

Language: Английский

---

Evaluating the impact of veterans expanded care legislation: a qualitative systematic review

Discover Health Systems, Journal Year: 2024, Volume and Issue: 3(1)

Published: Sept. 2, 2024

Abstract Background The Veterans Health Administration (VA) provides healthcare to over 9 million enrollees, and the desire further access for led passage of multiple new laws past decade including Choice Act (2014) MISSION (2018), which have collectively expanded Veteran eligibility VA-paid care delivered in community settings. This systematic review summarizes available evidence regarding patient provider perceptions these initiatives. Objectives To synthesize findings on (1) attitudes VA patients clinicians towards Acts (2) impact this legislation care. Design A qualitative as an synthesis relevant studies. Method Searches PubMed, Google Scholar, Embase APA PsycINFO electronic databases returned 1249 records, 23 met inclusion criteria using Cochrane approach synthesis. Results reveals significant insights into landscape veterans. Key results include challenges faced by navigating care, such complex scheduling billing issues. Primary Care Physicians highlighted difficulties continuity due administrative challenges. Positive aspects included enhanced especially rural veterans, although disparities persisted. Provider burnout was noted, particularly among those facing coordination Satisfaction levels varied, with factors like provider-patient relationship facility environment influencing choices. Notably, implementation improvements some respects but presented communication Conclusion underscores importance understanding experiences veterans within system its programs. shed light areas that require attention, addressing geographic improving between providers. Policymakers, administrators, researchers can leverage inform decision-making, enhance program efficacy, ultimately ensure receive optimal services.

Language: Английский

---

Socioeconomic Status Based on Area Deprivation Index Does Not Affect Postoperative Outcomes in Patients Undergoing Endovascular Aortic Aneurysm Repair in the VA Health-Care System

Annals of Vascular Surgery, Journal Year: 2024, Volume and Issue: 109, P. 245 - 255

Published: July 26, 2024

Language: Английский

---

Transforming Veteran Rehabilitation Care: Learnings from a Remote Digital Approach for Musculoskeletal Pain

Healthcare, Journal Year: 2024, Volume and Issue: 12(15), P. 1518 - 1518

Published: July 31, 2024

While musculoskeletal pain (MSP) stands as the most prevalent health condition among Veterans, timely and high-quality care is often hindered due to access barriers. Team Red, White & Blue (Team RWB), a nonprofit organization dedicated promoting healthier lifestyle aimed assess innovative approaches veteran care. This single-arm pilot study investigating feasibility, clinical outcomes, engagement, satisfaction of remote multimodal digital program Veterans with MSP. The impact deployment experience on outcomes was explored secondary aim. From 75 eligible 61 started program, reporting baseline frequently comorbid mental distress. Program acceptance suggested by high completion rate (82%) engagement levels, alongside (9.5/10, SD 1.0). Significant improvements were reported in all outcomes: (1.98 points, 95%CI 0.13; 3.84, p = 0.036); distress, those at least moderate depression ending mild symptoms (8.50 95%CI: 6.49; 10.51, 0.012); daily activity impairment (13.33 1.31; 25.34, 0.030). Deployed recovered similarly their counterparts. Overall, above results underscore potential intervention expand Veterans’ MSP

Language: Английский

---

Telehealth for Rural Veterans in the United States: A Systematic Review of Utilization, Cost Savings, and Impact of COVID-19

Societies, Journal Year: 2024, Volume and Issue: 14(12), P. 264 - 264

Published: Dec. 10, 2024

Veterans living in rural areas of the United States face various health challenges that demand timely access to care improve their well-being and quality life. Telehealth (i.e., use telecommunications technology connect people with providers remotely) has become vital addressing accessibility gap for constrained by vehicle ownership, income, geographic isolation, limited specialists. This study aims examine current evidence on veterans’ telehealth healthcare needs, evaluates cost savings associated telehealth, as well during COVID-19. Using Preferred Reporting Items Systematic Reviews Meta-Analyses (PRISMA) guidelines, a systematic search was conducted three databases (Google Scholar, PubMed, Scopus) select relevant articles published from 2017 2023. A total 36 met inclusion criteria were categorized into objectives: medical conditions managed through (n = 24), transportation using 4), COVID-19 pandemic 8). The results indicated is viable option managing veterans, including complex ones like diabetes cancer. Additionally, telemedicine useful platform bridging disasters or pandemics evident its increased usage pandemic. Lastly, time between USD 65.29 72.94 per visit 2.10 2.60 h visit, respectively. However, feasibility such rheumatism, cancer, HIV, underexplored calls further investigation post-COVID-19. literature different mobility options—taxi, Uber, public transportation, rides friends family—is another critical gap.

Language: Английский

---

Supporting Physical and Mental Health in Rural Veterans Living With Heart Failure: Protocol for a Nurse-Led Telephone Intervention Study (Preprint)

Published: June 21, 2024

Heart failure (HF) remains a disease of notable disparity for rural veterans, despite recent advancements in clinical treatment. Managing HF the home is stressful and complex veterans who experience unique barriers to optimal physical mental health, necessitating adequate support problem-solving skills. This study aims (1) adapt, sociocultural context, culturally sensitive, tailored, telephone intervention (CARE-HF [Supporting Physical Mental Health Rural Veterans With Failure]) using findings from preliminary qualitative research (2) evaluate effects CARE-HF on health outcomes among with HF. involves repeated-measures, single-group design. The content was adapted tailored context data guided by Theories Social Problem-Solving Stress, Appraisal, Coping. are recruited Administration home-based cardiac rehabilitation clinics, cardiology clinics that serve veterans-based community resource centers, social media campaigns. (N=100) receive intervention. nurse-led comprises 8 sessions use five-step, process manage common problems home: identifying problem viewing it positive manner, goal setting, (3) generating potential strategies management, (4) choosing implementing problem, (5) evaluating strategy effectiveness. initial training during first session, follow-up focusing skill reinforcement assisting applying these principles self-identified, HF-related experienced home. Data collected at baseline 3, 6, 12, 18 months interest (ie, self-care; symptoms; care utilization; depressive anxiety; HF-specific, health-related quality life; stress; resilience; coping). Demographic will be analyzed descriptive statistics multilevel growth curve modeling restricted maximum likelihood estimation compare series models Akaike information criteria Bayesian fit indices while controlling covariates. Recruitment started April 2023. As December 2024, we have enrolled 56 veterans. anticipated end June 2025, collection continuing until all completed 18-month period. Adapting testing aid has provide individualized where they reside, thereby reducing travel burden also increasing access evidence-based programs. If effective, interventions could low-cost, accessible method improve ClinicalTrials.gov NCT05839067; https://clinicaltrials.gov/study/NCT05839067 DERR1-10.2196/63498

Language: Английский

---