Where Virtual Care Was Already a Reality: Experiences of a Nationwide Telehealth Service Provider During the COVID-19 Pandemic

Background The COVID-19 pandemic has led to an increase in the use of and demand for telehealth services. Objective Here, we describe the utilization of telehealth services provided by Doctor On Demand, Inc., a well-known telehealth company in the United States, before and during the COVID-19 pandemic. We also explore how the number of virtual visits, reasons for visits, and patients served changed over time. Methods We reported data as a percentage change from the baseline week during 2 distinct time periods: February-June 2019 and February-June 2020 based on 4 categories of visits: respiratory illness, unscheduled behavioral health, scheduled behavioral health, and chronic illness. Results In 2020, the total visit volume increased considerably from March through April 7, 2020 (59% above the baseline) and then declined through the week of June 2 (15% above the baseline). Visits for respiratory illnesses increased through the week of March 24 (30% above the baseline) and then steadily declined through the week of June 2 (65% below the baseline). Higher relative increases were observed for unscheduled behavioral health and chronic illness visits through April (109% and 131% above the baseline, respectively) before a decline through the week of June 2 (69% and 37% above the baseline, respectively). Increases in visit volume among rural residents were slightly higher than those among urban residents (peak at 64% vs 58% above the baseline, respectively). Conclusions Although this telehealth service provider observed a substantial increase in the volume of visits during the COVID-19 pandemic, it is interesting to note that this growth was not fueled by COVID-19 concerns but by visits for behavioral health and chronic illness. Telehealth services may play a role as a “safety valve” for patients who have difficulty accessing care during a public health emergency.

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Where Virtual Care Was Already a Reality: Experiences of a Nationwide Telehealth Service Provider During the COVID-19 Pandemic (Preprint)

10.2196/preprints.22727 ◽

2020 ◽

Author(s):

Lori Uscher-Pines ◽

James Thompson ◽

Prentiss Taylor ◽

Kristin Dean ◽

Tony Yuan ◽

...

Keyword(s):

Chronic Illness ◽

Behavioral Health ◽

Service Provider ◽

Respiratory Illness ◽

The United States ◽

Respiratory Illnesses ◽

Telehealth Service ◽

Virtual Visits ◽

Reported Data ◽

Total Visit

BACKGROUND The COVID-19 pandemic has led to an increase in the use of and demand for telehealth services. OBJECTIVE Here, we describe the utilization of telehealth services provided by Doctor On Demand, Inc., a well-known telehealth company in the United States, before and during the COVID-19 pandemic. We also explore how the number of virtual visits, reasons for visits, and patients served changed over time. METHODS We reported data as a percentage change from the baseline week during 2 distinct time periods: February-June 2019 and February-June 2020 based on 4 categories of visits: respiratory illness, unscheduled behavioral health, scheduled behavioral health, and chronic illness. RESULTS In 2020, the total visit volume increased considerably from March through April 7, 2020 (59% above the baseline) and then declined through the week of June 2 (15% above the baseline). Visits for respiratory illnesses increased through the week of March 24 (30% above the baseline) and then steadily declined through the week of June 2 (65% below the baseline). Higher relative increases were observed for unscheduled behavioral health and chronic illness visits through April (109% and 131% above the baseline, respectively) before a decline through the week of June 2 (69% and 37% above the baseline, respectively). Increases in visit volume among rural residents were slightly higher than those among urban residents (peak at 64% vs 58% above the baseline, respectively). CONCLUSIONS Although this telehealth service provider observed a substantial increase in the volume of visits during the COVID-19 pandemic, it is interesting to note that this growth was not fueled by COVID-19 concerns but by visits for behavioral health and chronic illness. Telehealth services may play a role as a “safety valve” for patients who have difficulty accessing care during a public health emergency.

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Risk of Respiratory Illness Associated with Day-care Attendance: A Nationwide Study

PEDIATRICS ◽

10.1542/peds.87.1.62 ◽

1991 ◽

Vol 87 (1) ◽

pp. 62-69 ◽

Cited By ~ 1

Author(s):

Eugene S. Hurwitz ◽

Walter J. Gunn ◽

Paul F. Pinsky ◽

Lawrence B. Schonberger

Keyword(s):

Confidence Interval ◽

Day Care ◽

Odds Ratio ◽

Age Groups ◽

Respiratory Illness ◽

The United States ◽

Respiratory Illnesses ◽

Regular Care ◽

Increased Risk ◽

Older Siblings

The risk of respiratory and other illnesses in children (age groups: 6 weeks through 17 months, 18 through 35 months, and 36 through 59 months) in various types of day-care facilities was studied. Children considered exposed to day care were those who were enrolled in day care with at least one unrelated child for at least 10 hours per week in each of the 4 weeks before the interview; unexposed children were not enrolled in any regular child care with unrelated children and did not have siblings younger than 5 years of age receiving regular care with unrelated children. Although an increased risk of respiratory illness was associated with attending day care for children in all three age groups, this risk was statistically significant only for children 6 weeks through 17 months of age (odds ratio = 1.6; 95% confidence interval = 1.1 to 2.4) and children 18 through 35 months of age who had no older siblings (odds ratio = 3.4; 95% confidence interval = 2.0 to 6.0). In contrast, day-care attendance was not associated with an increased risk of respiratory illness in children 18 through 35 months of age with older siblings (odds ratio = 1.0). For children aged 6 weeks through 17 months, the exposure to older siblings was associated with an increased risk of respiratory illness; however, for children aged 36 through 59 months, older siblings were protective against respiratory illness. In addition, for the children in each age group currently in day care, increased duration of past exposure to day care was associated with a decreased risk of respiratory illness. It is estimated that during the period of the study approximately 10% of respiratory illnesses in the United States in children younger than 5 years of age were attributable to day-care attendance.

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The Halting Shadow

10.1093/oso/9780198729617.003.0011 ◽

2017 ◽

Author(s):

Deirdre David

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Sexual Desire ◽

Respiratory Illness ◽

Perforated Ulcer ◽

Respiratory Illnesses ◽

Dylan Thomas ◽

One Year

The last years of Pamela’s life were marked by further illness but also by a remarkable dedication to work. She was hospitalized several times for respiratory illnesses, but in 1974 she published a book of autobiographical essays, Important to Me, which covered such topics as memories of her father, her relationship with Dylan Thomas, her visits to the USSR, and her friendship with other writers such as Edith Sitwell. After months of undiagnosed pain, Snow died in 1980 of a perforated ulcer and Pamela died almost one year later of congestive heart failure and respiratory illness exacerbated by having smoked since the age of fourteen. Yet characteristically she worked courageously until the very end on a novel published posthumously: A Bonfire, which similarly to her first novel deals explicitly with sexual desire. Her ashes were scattered at Stratford-upon-Avon, a place she visited every year on Shakespeare’s birthday.

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Perinatal Mood and Anxiety Disorder Management in Multicenter Community Practices: Clinicians’ Training, Current Practices and Perceived Strategies to Improve Future Implementation

Journal of Primary Care & Community Health ◽

10.1177/2150132721996888 ◽

2021 ◽

Vol 12 ◽

pp. 215013272199688

Author(s):

Ajeng J. Puspitasari ◽

Dagoberto Heredia ◽

Elise Weber ◽

Hannah K Betcher ◽

Brandon J. Coombes ◽

...

Keyword(s):

Anxiety Disorder ◽

Health Services ◽

Behavioral Health ◽

Psychiatric Symptoms ◽

Medical Center ◽

Academic Medical Center ◽

Management Training ◽

The United States ◽

Behavioral Health Services ◽

Perinatal Women

Background: This study aimed to explore clinicians’ perspectives on the current practice of perinatal mood and anxiety disorder (PMAD) management and strategies to improve future implementation. Methods: This study had a cross-sectional, descriptive design. A 35-item electronic survey was sent to clinicians (N = 118) who treated perinatal women and practiced at several community clinics at an academic medical center in the United States. Results: Among clinicians who provided care for perinatal women, 34.7% reported never receiving PMAD management training and 66.3% had less than 10 years of experience. Out of 10 patients who reported psychiatric symptoms, 47.8% of clinicians on average reported providing PMAD management to 1 to 3 patients and 40.7% noted that they conducted screening only when patient expresses PMAD symptoms. Suggested future improvements were providing training, developing a referral list, and establishing integrated behavioral health services. Conclusions: Results from this study indicated that while PMAD screening and management was implemented, improvements are warranted to meet established guidelines. Additionally, clinicians endorsed providing PMAD management to a small percentage of perinatal patients. Suggested strategies to increase adoption and implementation of PMAD management should be explored to improve access to behavioral health services for perinatal women.

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Characteristics of wipe sampling methods for antineoplastic drugs in North America: comparison of six providers

Pharmaceutical Technology in Hospital Pharmacy ◽

10.1515/pthp-2020-0016 ◽

2020 ◽

Vol 5 (1) ◽

Author(s):

Claire Chabut ◽

Jean-François Bussières

Keyword(s):

Environmental Monitoring ◽

Service Provider ◽

Sampling Methods ◽

Service Providers ◽

Limit Of Detection ◽

The United States ◽

Antineoplastic Drugs ◽

Wipe Sampling ◽

Pubmed Database ◽

Google Search

Abstract Objectives Several societies have published guidelines to limit the occupational exposure of workers. Several of these guidelines recommend periodic (once or twice a year) environmental monitoring of specific sites where antineoplastic drugs are prepared and administered. However, most of the guidelines provide no guidance concerning which antineoplastic drugs should be monitored, the preferred sampling sites, appropriate test methods or limits of detection. The aim of this study was to characterize providers that quantify antineoplastic drug measured on surfaces. Methods This was a cross-sectional descriptive study. To identify service providers offering environmental monitoring tests, we searched the PubMed database and used the Google search engine. We contacted each service provider by email between June 3rd and June 15th, 2020. We specified the objective of our study and described the information needed and the variables of interest with standardized questions. Additional questions were sent by emails or via teleconferences. No statistical analyses were performed. Results We identified six providers offering services to Canadian hospitals, either based in Canada or in the United States. Five of these providers were private companies and one was a public organization. Each service provider was able to measure trace contamination of 3–17 antineoplastic drugs. Five of the providers quantified drugs using ultra performance liquid chromatography coupled with tandem mass spectrometry (UPLC-MSMS), which allowed for lower LODs. The sixth provider offered quantification by immunoassay, which has higher LODs, but offers near real-time results; the surface area to be sampled with this method was also smaller than with UPLC-MSMS. The services offered varied among the service providers. The information about LODs supplied by each provider was often insufficient and the units were not standardized. A cost per drug quantified could not be obtained, because of variability in the scenarios involved (e.g. drug selection to be quantified, number of samples, nondisclosure of ancillary costs). Four of the six service providers were unable to report LOQ values. Conclusions Few data are available from Canadian service providers concerning the characteristics of wipe sampling methods for antineoplastics. This study identified six north-American providers. Their characteristics were very heterogeneous. Criteria to consider when choosing a provider include the validation of their analytical method, a low limit of detection, the choice of drugs to be quantified and the sites to be sampled, obtaining details about the method and understanding its limits, and price. This should be part of a structured multidisciplinary approach in each center.

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Influenza vaccine effectiveness against hospitalization in the United States, 2019-2020

The Journal of Infectious Diseases ◽

10.1093/infdis/jiaa800 ◽

2020 ◽

Author(s):

Mark W Tenforde ◽

H Keipp Talbot ◽

Christopher H Trabue ◽

Manjusha Gaglani ◽

Tresa M McNeal ◽

...

Keyword(s):

United States ◽

Influenza Vaccine ◽

Influenza Vaccination ◽

Respiratory Illness ◽

The United States ◽

Vaccine Effectiveness ◽

Influenza Viruses ◽

Current Season ◽

Hospital Resources ◽

Negative Controls

Abstract Background Influenza causes significant morbidity and mortality and stresses hospital resources during periods of increased circulation. We evaluated the effectiveness of the 2019-2020 influenza vaccine against influenza-associated hospitalizations in the United States. Methods We included adults hospitalized with acute respiratory illness at 14 hospitals and tested for influenza viruses by reserve transcription polymerase chain reaction. Vaccine effectiveness (VE) was estimated by comparing the odds of current-season influenza vaccination in test-positive influenza cases versus test-negative controls, adjusting for confounders. VE was stratified by age and major circulating influenza types along with A(H1N1)pdm09 genetic subgroups. Results 3116 participants were included, including 18% (553) influenza-positive cases. Median age was 63 years. Sixty-seven percent (2079) received vaccination. Overall adjusted VE against influenza viruses was 41% (95% confidence interval [CI]: 27-52). VE against A(H1N1)pdm09 viruses was 40% (95% CI: 24-53) and 33% against B viruses (95% CI: 0-56). Of the two major A(H1N1)pdm09 subgroups (representing 90% of sequenced H1N1 viruses), VE against one group (5A+187A,189E) was 59% (95% CI: 34-75) whereas no significant VE was observed against the other group (5A+156K) [-1%, 95% CI: -61-37]. Conclusions In a primarily older population, influenza vaccination was associated with a 41% reduction in risk of hospitalized influenza illness.

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