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      Telehealth in the COVID-19 Era: A Balancing Act to Avoid Harm

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          Abstract

          The telehealth revolution in response to COVID-19 has increased essential health care access during an unprecedented public health crisis. However, virtual patient care can also limit the patient-provider relationship, quality of examination, efficiency of health care delivery, and overall quality of care. As we witness the most rapidly adopted medical trend in modern history, clinicians are beginning to comprehend the many possibilities of telehealth, but its limitations also need to be understood. As outcomes are studied and federal regulations reconsidered, it is important to be precise in the virtual patient encounter approach. Herein, we offer some simple guidelines that could assist health care providers and clinic schedulers in determining the appropriateness of a telehealth visit by considering visit types, patient characteristics, and chief complaint or disease states.

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          Most cited references31

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          Covid-19 and Health Care’s Digital Revolution

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            State of Telehealth.

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              Patient Satisfaction With Telemedicine During the COVID-19 Pandemic: Retrospective Cohort Study

              Background New York City was the international epicenter of the COVID-19 pandemic. Health care providers responded by rapidly transitioning from in-person to video consultations. Telemedicine (ie, video visits) is a potentially disruptive innovation; however, little is known about patient satisfaction with this emerging alternative to the traditional clinical encounter. Objective This study aimed to determine if patient satisfaction differs between video and in-person visits. Methods In this retrospective observational cohort study, we analyzed 38,609 Press Ganey patient satisfaction survey outcomes from clinic encounters (620 video visits vs 37,989 in-person visits) at a single-institution, urban, quaternary academic medical center in New York City for patients aged 18 years, from April 1, 2019, to March 31, 2020. Time was categorized as pre–COVID-19 and COVID-19 (before vs after March 4, 2020). Wilcoxon-Mann-Whitney tests and multivariable linear regression were used for hypothesis testing and statistical modeling, respectively. Results We experienced an 8729% increase in video visit utilization during the COVID-19 pandemic compared to the same period last year. Video visit Press Ganey scores were significantly higher than in-person visits (94.9% vs 92.5%; P<.001). In adjusted analyses, video visits (parameter estimate [PE] 2.18; 95% CI 1.20-3.16) and the COVID-19 period (PE 0.55; 95% CI 0.04-1.06) were associated with higher patient satisfaction. Younger age (PE –2.05; 95% CI –2.66 to –1.22), female gender (PE –0.73; 95% CI –0.96 to –0.50), and new visit type (PE –0.75; 95% CI –1.00 to –0.49) were associated with lower patient satisfaction. Conclusions Patient satisfaction with video visits is high and is not a barrier toward a paradigm shift away from traditional in-person clinic visits. Future research comparing other clinic visit quality indicators is needed to guide and implement the widespread adoption of telemedicine.
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                Author and article information

                Contributors
                Journal
                J Med Internet Res
                J Med Internet Res
                JMIR
                Journal of Medical Internet Research
                JMIR Publications (Toronto, Canada )
                1439-4456
                1438-8871
                February 2021
                1 February 2021
                1 February 2021
                : 23
                : 2
                : e24785
                Affiliations
                [1 ] Department of Surgery University of California San Diego La Jolla, CA United States
                [2 ] Department of Medicine Division of Biomedical Informatics University of California San Diego La Jolla, CA United States
                Author notes
                Corresponding Author: J Jeffery Reeves jreeves@ 123456ucsd.edu
                Author information
                https://orcid.org/0000-0002-7438-2625
                https://orcid.org/0000-0002-8831-8691
                https://orcid.org/0000-0003-4908-6856
                Article
                v23i2e24785
                10.2196/24785
                7857524
                33477104
                028dd93c-4aa7-46ef-8165-469377ef8e1e
                ©J Jeffery Reeves, John W Ayers, Christopher A Longhurst. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 01.02.2021.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.

                History
                : 5 October 2020
                : 18 November 2020
                : 20 December 2020
                : 16 January 2021
                Categories
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                Medicine
                telehealth,patient safety,covid-19,coronavirus,informatics,safety,harm,risk,access,efficiency,virtual care
                Medicine
                telehealth, patient safety, covid-19, coronavirus, informatics, safety, harm, risk, access, efficiency, virtual care

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