Biology - Physiology WRITING ASSIGNMENT #5 FOR CAPSTONE: Discussion and Conclusion 5-9 pages (minimum of five complete pages of text)

A SYSTEMATIC REVIEW OF THE EFFECTIVENESS OF TELEHEALTH/TELEMEDICINE

IN IMPROVING ACCESS TO CARE AND PATIENT SATISFACTION

Student Name

Capstone Project

In partial fulfillment of the degree Master of Public Health

National University

End of Course Date

I accept this capstone project on behalf of the Community Health Department, School of Health and Human Services, National University. Below the faculty who taught the capstone course, and the MPH Program Director will sign.

__________________________________________ ___________

Faculty/Professor of Capstone Date

Brandon Eggleston PhD

__________________________________________ ___________

MPH Program Director Date

Tyler Smith PhD

iii

CHAPTER 5. CONCLUSIONS AND RECOMMENDATION

Introduction

This chapter provides the implications for the research hypothesis: Telehealth or Telemedicine has improved access to care and increased patient satisfaction in various health care services before, during, and maybe after COVID 19 Pandemic.

The systematic review consisted of 50 articles that acknowledged a number of evidence that telehealth and telemedicine contributed to the expansion of access to healthcare in various locations and health services. Additionally, telehealth and telemedicine elevated patients' satisfaction in many aspects of healthcare. In rural health areas, telehealth can assist healthcare systems, organizations, and providers expand access to and improving healthcare quality. The use of telehealth in rural areas as a healthcare delivery avenue can reduce or minimize challenges and burdens patients encounter, such as transportation issues related to travel for specialty care (Fortney et al., 2013). Hence, telehealth can also improve monitoring, timeliness, and communications within the healthcare system.

Telehealth became a more prominent platform for providing healthcare during the COVID -19 pandemic when patients and providers sought to decrease in-person contact for routine visits. The implementation and continued expansion of telehealth services assist various healthcare organizations in delivering care during the COVID-19 global pandemic.

The study conducted by Bate et al. (2021) in Melbourne, Australia, revealed an excellent overall acceptance, satisfaction, and willingness for patients, parents, and clinicians to use telehealth in the future. The authors then added that as more and more people are exposed to telemedicine and the rapid cyclical disruption of COVID‐19 eventually plateaus, telehealth should be looked at for further mass expansion in the digital era (Bate et al., 2021).

According to Demeke et al. (2021), while the resumption of in-person health care visits is anticipated when COVID – 19 pandemic subsides, telehealth will still be a critical factor in improving access to health care, especially among populations with limited access to care and enhancing the U.S. health care system's capacity to continue in future pandemics. For example, funded health centers have played a critical role as primary care providers by providing testing, treatment, and preventive care, including vaccination. Sustaining expanded use of telehealth visits in health centers during and after the pandemic might require continuation of existing flexibilities provided under Centers for Medicare & Medicaid Services telehealth reimbursement policies and local level considerations of additional support and resources (Demeke et al., 2021).

Sundstrom et al. (2019) conducted a study about the role of telehealth in providing access to women needing contraceptives in Rural South Carolina. Telehealth paved the way for health communicators to inform rural women of their choices in contraceptive methods, implementing effective campaigns and interventions to decrease unplanned pregnancy through improved access. They found out that telehealth initiatives address barriers to contraceptive entry in rural locations. Furthermore, participants discussed the advantages of telehealth, such as reduced travel distances and saving costs such as gas and transportation to access contraceptive services. These findings provide theoretical and practical opportunities to guide telehealth interventions and health communication campaigns to increase contraceptive uptake and decrease unintended pregnancies among women living in rural areas (Sundstrom et al., 2019).

To show that telehealth improves patient satisfaction, a study conducted by Wilkinson et al. (2016) proves high patient satisfaction with telehealth use in patients with Parkinson's disease. The authors stated that telehealth showed similar results to clinical outcomes. It was found in the research that greater satisfaction for the telehealth modality was found in assessments of convenience and accessibility/distance. Although certain aspects of the neurologic examination cannot be completed remotely (e.g., pull test and muscle tone assessment), most movement disorder–related exams are conducive to an audiovisual approach using the modified version of test models (Wilkinson et al., 2016). In conclusion, researchers stated that as the need for Parkinson's disease subspecialty care increases, innovative patient-centered solutions to overcoming barriers to access, such as video telehealth, will be invaluable to patients and provide high patient satisfaction.

A study by Cho et al. (2021) stated that cardiology patients reported overall satisfaction with telehealth during the COVID-19 pandemic. The research identified factors associated with patient convenience, gender, younger age, and non-white ethnicity correlated with greater satisfaction. The authors then stated that further research into telehealth's impact on patient satisfaction, safety, and clinical outcome is needed.

Waqar-Cowles et al. (2021) identified that there are encouraging signs that telehealth may be a viable method to deliver pediatric rheumatology care in the future. The research explained that most patients and caregivers reported positive experiences across all telehealth assessment sub-scales. Furthermore, patients and families familiar with telehealthcare were more likely to consider telehealth equal or preferable to in-person visits. Acceptability may increase with greater exposure to video visits and application in more targeted cases and when pediatric rheumatology providers have more familiarity with telehealth delivery and identify more optimal use cases (Waqar-Cowles et al., 2021). Research and innovation are needed to determine how evolving telehealth technology can help providers perform virtual exams with high fidelity and safety, thereby improving pediatric rheumatology telehealth delivery.

The study conducted by Ruelos et al. (2021) about the perception of orthopedic patients regarding telehealth use stated that the majority of patients expressed that the system was easy to use (90.0%), is convenient (86.7%), and saves them time (83.3%). Additionally, nearly all (95%) patients agreed that their surgeon could answer their questions using the technology. Patient perspectives on the widespread adoption of telehealth, such as ease of use, privacy protection, and convenience, showed that these anticipated barriers might be some of the most significant advantages of telehealth (Ruelos et al., 2021).

The COVID-19 pandemic may have provided the momentum for telehealth to become a mainstay of many healthcare services as a form of care delivery in the future. However, many aspects need to be addressed so that the benefits of this technology can be maximized.

Limitations

The articles included in this study were all peer-reviewed articles published from 2008 to 2022. Credible online resources and books were not included as they posed potential coding complications and data analysis issues. For these reasons, the review may not have examined other pertinent articles. The majority of the included research was conducted in the U.S., Canada, Australia, and Great Britain. Due to this, this study may not have captured the whole picture as results from other places may not have been accounted. Although, there is the certainty that the results may not have differed significantly if more articles had been included.

Conclusion

Telehealth and telemedicine play an essential part in widening access to care and improving patient satisfaction. COVID – 19 pandemic has launched the popularity and usefulness of this technology in many facets of healthcare. Telehealth has poised not only for convenience for patients, but it has the potential to provide so many further benefits, including improving public health, relieving pressure on the healthcare workforce, and helping to reduce financial stress to many. Some of the studies identified barriers that hinder the telehealth/telemedicine system; such barriers were human factors in using the technology, training, conflicting state policies, and privacy. These barriers are worth visiting for future studies to address and perhaps draw a bigger picture of telehealth and telemedicine as valuable assets to the healthcare system.

Recommendations for Further Study

In this study, many articles focused on the patient, yet patient care does not only include patients, but also consists of the system and providers. Future studies may include looking at the other side of patient care on how telehealth affects doctors, nurses, and other healthcare providers. It is also essential to study how a unified telehealth system in the United States can be achieved. This will assist lawmakers and advocates in pressing the approval of existing policy proposals waiting for debates and discussions in the senate and congress. Some examples of proposed telehealth acts are S. 1704/H.R. 5981 (Telehealth Expansion Act 2021), H.R. 5506 (Rural Telehealth Access Task Force Act), and H.R. 4480 (Telehealth Coverage and Payment Parity Act). Along with many other proposed laws, it is crucial to public health professionals and advocates to keep awareness of the benefits of the telehealth system in the open to address any gaps in health not just for people living in remote places but for all who want to avail these kinds of services.

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Schulder Rheuban, K., & Krupinski, E. A. (2018). Understanding telehealth access medicine. McGraw-Hill Medical. https://accessmedicine.mhmedical.com/book.aspx?bookID=2217#187794411

Scott, R., & Mars, M. (2015). Telehealth in the developing world: Current status and future prospects. Smart Homecare Technology and TeleHealth, 2015, 25. https://doi.org/10.2147/SHTT.S75184

Sharma, A., Bowman, R., Ettema, S. L., Gregory, S. R., Javadi, P., Johnson, M. D., Butcher, M. L., Mutua, E., Stack, B. C., & Crosby, D. L. (2021). Rapid telehealth implementation into an otolaryngology practice during the COVID ‐19 pandemic. Laryngoscope Investigative Otolaryngology, 6(3), 386–393. https://doi.org/10.1002/lio2.552

Steindal, S. A., Nes, A. A. G., Godskesen, T. E., Dihle, A., Lind, S., Winger, A., & Klarare, A. (2020). Patients’ experiences of telehealth in palliative home care: Scoping review. Journal of Medical Internet Research, 22(5), e16218. https://doi.org/10.2196/16218

Stout, K. A., & Martinez, K. (2011). Telehealth forging ahead: Overcoming barriers in licensure to improve access to Care for service members. International Journal of Telerehabilitation, 3(2), 23–26. https://doi.org/10.5195/IJT.2011.6081

Waqar-Cowles, L. N., Chuo, J., Weiss, P. F., Gmuca, S., LaNoue, M., & Burnham, J. M. (2021). Evaluation of pediatric rheumatology telehealth satisfaction during the COVID-19 pandemic. Pediatric Rheumatology, 19(1), 170. https://doi.org/10.1186/s12969-021-00649-4

Watts, K. A., Malone, E., Dionne‐Odom, J. N., McCammon, S., Currie, E., Hicks, J., Tucker, R. O., Wallace, E., Elk, R., & Bakitas, M. (2021). Can you hear me now?: Improving palliative care access through telehealth. Research in Nursing & Health. http://dx.doi.org/10.1002/nur.22105

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APPENDIX A. ARTICLE SELECTION PROCESS

Figure 1. Study Selection Flow Diagram

APPENDIX B. SYSTEMATIC LITERATURE REVIEW

Table 1. List of Reviewed Articles

Author, Year	Article Title	Focus of study
Jones et al., 2012	Acceptability and cost-effectiveness of military telehealth mental health screening.	Access to Care
Weissman et al., 2020	Access to evidence-based Care for eating disorders during the COVID-19 crisis	Access to Care
Jester et al., 2020	Changes in access to educational and healthcare services for individuals with intellectual and developmental disabilities during COVID‐19 restrictions	Access to Care
Jong et al., 2019	Enhancing access to care in northern rural communities via telehealth	Access to Care
Pal et al., 2021	Enhancing Cancer care of rural dwellers through telehealth and engagement (ENCORE): protocol to evaluate effectiveness of a multi-level telehealth-based intervention to improve rural cancer care delivery	Access to Care
Bate et al., 2021	Effect of the COVID‐19 induced phase of massive telehealth uptake on end‐user satisfaction	Access to care & Patient satisfaction
Reisinger-Kindle et al., 2021	Evaluation of rapid telehealth implementation for prenatal and postpartum Care visits during the COVID-19 pandemic in an academic clinic in Springfield, Massachusetts, United States of America	Access to care
Goncalves et al., 2017	Expanding Primary Care Access: A Telehealth Success Story	Access to Care
Young et al., 2011	Home Telehealth: Patient Satisfaction, Program Functions, and Challenges for the Care Coordinator	Patient satisfaction
Dean et al., 2019	Improving value and access to specialty medical care for families: a pediatric surgery telehealth program	Access to care & Patient satisfaction
Nicosia et al., 2021	Leveraging Telehealth to improve access to Care: a qualitative evaluation of Veterans’ experience with the VA TeleSleep program	Access to Care
Polinski et al., 2016	Patients’ Satisfaction with and Preference for Telehealth Visits	Access to Care
Chang et al., 2021	Rapid Transition to Telehealth and the Digital Divide: Implications for Primary Care Access and Equity in a Post-COVID Era	Access to Care
Jhaveri et al., 2020	"Soup cans, brooms, and Zoom:" Rapid conversion of a cancer survivorship program to telehealth during COVID-19	Access to care & Patient satisfaction
Imlach et al., 2020	Telehealth consultations in general practice during a pandemic lockdown: survey and interviews on patient experiences and preferences	Access to care & Patient satisfaction
O’Donovan et al., 2020	Telehealth for delivery of hemophilia comprehensive care during the COVID-19 pandemic	Access to care & Patient satisfaction
Aziz et al., 2020	Telehealth for High-Risk Pregnancies in the Setting of the COVID-19 Pandemic	Access to care
Gadenz et al., 2021	Telehealth to support referral management in a universal health system: a before-and- after study	Access to Care
Young et al., 2017	Telehealth: Increasing Access to High Quality Care by Expanding the Role of Technology in Correctional Medicine	Access to Care
Powell et. Al., 2018	Patient and Health System Experience with Implementation of an Enterprise-Wide Telehealth Scheduled Video Visit Program: Mixed-Methods Study	Access to care & Patient satisfaction
Garvin et at., 2021	Use of Video Telehealth Tablets to Increase Access for Veterans Experiencing Homelessness	Access to Care
Layfield et al., 2020	Telemedicine for head and neck ambulatory visits during COVID‐19: Evaluating usability and patient satisfaction	Patient satisfaction
White et al., 2022	The qualitative experience of telehealth access and clinical encounters in Australian healthcare during COVID-19: implications for policy	Access to Care
Hobson et al., 2019	Using telehealth in motor neuron disease to increase access to specialist multidisciplinary Care: a UK-based pilot and feasibility study	Access to Care
Gilkey et al., 2021	Using Telehealth to Deliver Primary Care to Adolescents During and After the COVID-19 Pandemic: National Survey Study of US Primary Care Professionals	Access to Care
Bradford et al., 2015	Awareness, experiences and perceptions of telehealth in a rural Queensland community	Patient satisfaction
Jeste et al., 2020	Changes in access to educational and healthcare services for individuals with intellectual and developmental disabilities during COVID‐19 restrictions	Patient satisfaction
Adams et al., 2021	Patient satisfaction and acceptability with telehealth at specialist medical outpatient clinics during the COVID-19 pandemic in Australia	Patient satisfaction
Steindal et al., 2020	Patients’ Experiences of Telehealth in Palliative Home Care: Scoping Review	Patient satisfaction
Rutherford et al., 2020	Potential Benefits and Drawbacks of Virtual Clinics in General Surgery: Pilot Cross-Sectional Questionnaire Study	Patient satisfaction
Sharma et al., 2021	Rapid telehealth implementation into an otolaryngology practice during the COVID-19 pandemic	Patient satisfaction
Paterson et al., 2020	The Role of Telehealth During the COVID-19 Pandemic Across the Interdisciplinary Cancer Team: Implications for Practice	Patient satisfaction
O’Connor et al., 2016	Using Telehealth to Reduce All-Cause 30-Day Hospital Readmissions among Heart Failure Patients Receiving Skilled Home Health Services	Patient satisfaction
Gordon et al., 2017	Virtual Visits for Acute, Nonurgent Care: A Claims Analysis of Episode-Level Utilization	Patient satisfaction
Graziano et al., 2021	Psychological interventions during COVID pandemic: Telehealth for individuals with cystic fibrosis and caregivers	Patient satisfaction
Howren et al., 2020	Virtual rheumatology appointments during the COVID-19 pandemic: an international survey of perspectives of patients with rheumatic diseases	Patient satisfaction
Young et al., 2011	Home Telehealth: Patient Satisfaction, Program Functions, and Challenges for the Care Coordinator	Patient satisfaction
Bove et al., 2013	Managing hypertension in urban underserved subjects using telemedicine—A clinical trial	Patient satisfaction
Ly et al., 2017	The individual and contextual determinants of the use of telemedicine: A descriptive study of the perceptions of Senegal’s physicians and telemedicine projects managers	Patient satisfaction
Ashwood et al., 2017	Direct-To-Consumer Telehealth May Increase Access to Care but Does Not Decrease Spending	Access to Care
Watts et al., 2021	Can you hear me now? Improving palliative care access through telehealth	Access to Care
Stingley & Schultz, 2014	Helmsley Trust Support For Telehealth Improves Access to Care in Rural And Frontier Areas	Access to care
Nandra et al., 2019	Telehealth provides a comprehensive approach to the surgical patient	Access to Care
Sundstrom et al., 2019	“The Closer, the Better:” The Role of Telehealth in Increasing Contraceptive Access Among Women in Rural South Carolina	Access to Care
Perez, 2021	Expanding Access to Specialty Care Using Video-Telehealth: The Case for Functional Neurological Disorder	Access to Care
Maurice et al., 2020	Improving Access to Bariatric Surgery for Rural and Remote Patients: Experiences from a State-Wide Bariatric Telehealth Service in Australia	Access to Care
Moffat & Eley, 2010	The reported benefits of telehealth for rural Australians	Access to Care
Brenes et al., 2011	Benefits and Challenges of Conducting Psychotherapy by Telephone	Access to Care
Bhatia, 2021	Telehealth and COVID-19: Using technology to accelerate the curve on access and quality healthcare for citizens in India	Access to care
Seto et al., 2019	Opportunities and Challenges of Telehealth in Remote Communities: Case Study of the Yukon Telehealth System	Access to Care

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