University of California, San Francisco (UCSF)

Your doctor's ready: Please log in to the videoconference

Coronavirus may change patient appointments permanently, say UCSF researcher

Newswise — The coronavirus has prompted many medical centers to switch from in-person appointments to video visits. A new study from UCSF Benioff Children's Hospitals suggests that for some hospitals, video visits may become a permanent feature of the patient-provider landscape.

Prior to March 2020, all patients at the UCSF Adolescent and Young Adult Clinic received medical care through in-person visits. By the end of March, 97 percent of visits -- approximately 80 appointments per week -- were done via videoconferencing with physicians or nurse practitioners, according to the study publishing June 3, 2020, in the Journal of Adolescent Health.

"This has been a complex transition because we have had to navigate the uncertain waters of parent and adolescent/young adult involvement and confidentiality," said senior author Marissa Raymond-Flesch, MD, of the UCSF Division of Adolescent and Young Adult Medicine. "However, after the current coronavirus crisis, we expect to maintain telehealth in many areas.

"Patients will be able to complete video visits from school or work, or any setting that they identify as adequately private," Raymond-Flesch said. "This is a new domain in our field, and we are excited about reducing disparities in care in underserved areas such as rural communities."

The clinic serves patients ages 12 to 25, of whom three-quarters are female, from a catchment area spanning 400 miles north to the Oregon border and roughly 100 miles east to the Central Valley. Service includes both general health care and specialty care in attention and mood disorders, sexual and reproductive health, eating disorders and addictions.

Virtual Waiting Rooms Protect Patient Privacy

In their study, the UCSF researchers used a videoconferencing platform that was compliant with the Health Insurance Portability and Accountability Act, which protects the privacy of health information and security of electronic records. To prevent third-party access, they created a virtual waiting room, requiring a doctor to authorize entrance for each visitor. The visits were streamed -- like FaceTime or Google Hangouts -- rather than recorded. They also identified ways for patients to share information without risking disclosure to people within earshot, such as by using headphones and responding to sensitive questions with "yes" or "no," as well as using the chat function to type responses.

"The telehealth visit is a new reality and one that presents unique challenges," said Raymond-Flesch. "While you can see the patient's face, you cannot make direct eye-contact and you cannot demonstrate compassion by offering a tissue or a gentle pat on the arm. I found it meant that I had to exaggerate facial expressions or offer more verbal assurance than I would have done in actual visits."

The researchers reported that virtual visits did not present a barrier in screening patients for depression, substance use or psycho-social development. Additionally, clinicians were able to provide contraceptive counselling and appropriate follow-up for established diagnoses like headache, acne and back pain; and they reported that they were comfortable managing mood disorders and medication maintenance for attention deficit hyperactivity, with referrals made to psychiatrists for some conditions.

More challenging were appointments that required exams and procedures. Patients needing vaccines or tests for pregnancy, sexually transmitted diseases, urinary-tract infections or high cholesterol required an in-person visit with a nurse or phlebotomist. While the researchers have not considered using devices such as electronic stethoscopes, which enable providers from a second clinic to stream data directly to the consulting site, they said patient-owned devices such as an Apple watch or blood pressure monitor and upper-arm cuff may be used in the future, pending tests for accuracy.

Weight Checks a Challenge for Patients with Eating Disorders

Virtual care for patients with eating disorders, who make up about a third of the clinic's patients, required significant workarounds to provide regular monitoring of weight, vital signs and electrolytes. Weight checks, in particular, can be very stressful for these patients and many prefer to not know their weight. In some cases, primary care providers or therapists were able to weigh patients and take vital signs, which they shared with the clinic. In other cases, a parent or trusted adult was tasked with weighing the patient and relaying that information in private to the clinician.

"There were concerns that patients would overhear their weight or learn of nutritional interventions that normally parents would discuss confidentially with the physician during an in-person appointment," said Raymond-Flesch. "But on the upside, many families travel significant distances to reach us. Telemedicine may have allowed for increased parental participation," she said noting that patients with eating disorders were referred from a much broader geographic range than primary-care patients.

In addition to improved accessibility, telemedicine also opened the door to collaboration with primary-care providers. "It's something that has been considered before but never implemented," said first author and clinical fellow Angela Barney, MD, of the UCSF Division of Adolescent and Young Adult Medicine.

"There's a sense that many of the changes are not just temporary responses, but rather the new normal," she said. "We are not proposing that telemedicine for adolescents and young adults will replace in-person visits, but we can look at this quick shift as an opportunity to reach our patient population in new ways, both in this time of crisis and beyond."

###

Co-Authors: Sara Buckelew, MD, and Veronika Mesheriakova, MD, of the UCSF Division of Adolescent and Young Adult Medicine.

Funding and Disclosures: The study was supported by funding from the Maternal and Child Health Bureau, National Institute of Child Health and Development, UCSF Watson Scholars Program, National Institutes of Health, UCSF Youth Outpatient Substance Use Program and the California Department of Health Care Services. There are no conflicts of interests to disclose.

About UCSF Health: UCSF Health is recognized worldwide for its innovative patient care, reflecting the latest medical knowledge, advanced technologies and pioneering research. It includes the flagship UCSF Medical Center, which is ranked among the top 10 hospitals nationwide, as well as UCSF Benioff Children's Hospitals, with campuses in San Francisco and Oakland, Langley Porter Psychiatric Hospital and Clinics, UCSF Benioff Children's Physicians and the UCSF Faculty Practice. These hospitals serve as the academic medical center of the University of California, San Francisco, which is world-renowned for its graduate-level health sciences education and biomedical research. UCSF Health has affiliations with hospitals and health organizations throughout the Bay Area. Visit http://www.ucsfhealth.org/. Follow UCSF Health on Facebook or on Twitter.

SEE ORIGINAL STUDY



Filters close

Showing results

110 of 5827
Newswise: Data and Safety Review Board Reports How it Monitored the COVID-19 Vaccine Trials
Released: 15-Jun-2021 2:55 PM EDT
Data and Safety Review Board Reports How it Monitored the COVID-19 Vaccine Trials
University of Alabama at Birmingham

Evaluation of three vaccine candidates during the COVID-19 pandemic fell to 12 experts of the federally appointed COVID-19 Vaccine Data and Safety Monitoring Board. This team has now taken the unusual step of publishing details of their review process in The Journal of Infectious Diseases.

Released: 15-Jun-2021 1:55 PM EDT
NCCN Policy Summit Explores How COVID-19 Pandemic Can Lead to Improvements in Cancer Care
National Comprehensive Cancer Network® (NCCN®)

NCCN Policy Summit examines the impact of the past year on oncology policy in the U.S., such as resuming recommended screening and clinical trials, applying health innovations from the COVID-19 pandemic to cancer treatment, and addressing systemic inequalities that lead to disparities in outcomes.

access_time Embargo lifts in 2 days
Embargo will expire: 17-Jun-2021 11:00 AM EDT Released to reporters: 15-Jun-2021 1:20 PM EDT

A reporter's PressPass is required to access this story until the embargo expires on 17-Jun-2021 11:00 AM EDT The Newswise PressPass gives verified journalists access to embargoed stories. Please log in to complete a presspass application. If you have not yet registered, please Register. When you fill out the registration form, please identify yourself as a reporter in order to advance to the presspass application form.

Released: 15-Jun-2021 1:05 PM EDT
Common cold combats COVID-19
Yale University

Exposure to the rhinovirus, the most frequent cause of the common cold, can protect against infection by the virus which causes COVID-19, Yale researchers have found.

Released: 15-Jun-2021 11:55 AM EDT
Researchers Develop More Reliable Rapid Tests for COVID-19
University of Maryland Medical Center

Researchers Develop More Reliable Rapid Tests for COVID-19 Public Release Date: 15-Jun-2021 00:00:00 US Eastern Time (24hr) Research News Release Contact Person: Deborah Kotz Contact Phone: 410-706-4255 Contact E-mail: Journal: Nature Protocols DOI: 10.1038/s41596-021-00546-w Funder: Grant Number(s): Meeting: Primary Keyword: Medicine/Health Keywords: Medicine/Health -> Diagnostics Medicine/Health -> Infectious/Emerging Diseases Subtitle: Tests Use Innovative Techniques That Improve Accuracy Rivaling Gold Standard PCR Test Summary: Researchers at the University of Maryland School of Medicine (UMSOM) have developed two rapid diagnostic tests for COVID-19 that are nearly as accurate as the gold-standard test currently used in laboratories. Unlike the gold standard test, which extracts RNA and uses it to amplify the DNA of the virus, these new tests can detect the presence of the virus in as little as five minutes using different methods.

Newswise: SARS-CoV-2 Worldwide Replication Drives Rapid Rise and Selection of Mutations
Released: 15-Jun-2021 11:40 AM EDT
SARS-CoV-2 Worldwide Replication Drives Rapid Rise and Selection of Mutations
UCLA Fielding School of Public Health

The number of COVID-19 variants is growing rapidly, so much that the scale and scope of mutation may pose a threat to the continuing successful use of the current vaccines and therapies. The findings, by an international team that includes University of California researchers, are being published in the June edition of the peer-reviewed journal EMBO Molecular Medicine. The pace of variation of the SARS-CoV-2 virus strains makes plain the threat that rapidly evolving new strains might give rise to escape variants, capable of limiting the efficacy of vaccines, therapies, and diagnostic tests.

Newswise:Video Embedded what-makes-us-sneeze
VIDEO
14-Jun-2021 5:20 PM EDT
What makes us sneeze?
Washington University in St. Louis

What exactly triggers a sneeze? A team led by researchers at Washington University School of Medicine in St. Louis has identified, in mice, specific cells and proteins that control the sneeze reflex. Better understanding of what causes us to sneeze — specifically how neurons behave in response to allergens and viruses — may point to treatments capable of slowing the spread of infectious respiratory diseases.

Newswise: Virtual Event For June 17, 11AM EDT: COVID-19 Vaccines and Male Fertility
Released: 15-Jun-2021 8:55 AM EDT
Virtual Event For June 17, 11AM EDT: COVID-19 Vaccines and Male Fertility
Newswise

This upcoming JAMA-published study examined whether the COVID-19 vaccine impacts male fertility.

14-Jun-2021 11:40 AM EDT
Rapid exclusion of COVID-19 infection using AI, EKG technology
Mayo Clinic

Artificial intelligence (AI) may offer a way to accurately determine that a person is not infected with COVID-19. An international retrospective study finds that infection with SARS-CoV-2, the virus that causes COVID-19, creates subtle electrical changes in the heart. An AI-enhanced EKG can detect these changes and potentially be used as a rapid, reliable COVID-19 screening test to rule out COVID-19 infection.


Showing results

110 of 5827

close
1.64374