Галерея 2785802

Галерея 2785802

Reference #18.8c85655f.1678357390.aba1999

Alle Titel TV-Folgen Prominente Unternehmen Stichwörter Erweiterte Suche
Vollständig unterstützt English (United States) Teilweise unterstützt Français (Canada) Français (France) Deutsch (Deutschland) हिंदी (भारत) Italiano (Italia) Português (Brasil) Español (España) Español (México)
Bearbeitung vorschlagen oder fehlenden Inhalt hinzufügen
Sie haben keine kürzlich angezeigten Seiten.
Melde dich an für Zugriff auf mehr Inhalte Melde dich an für Zugriff auf mehr Inhalte

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue

Terms of Use
|
Privacy Policy
|
Accessibility Statement

2023 American Medical Association. All Rights Reserved

Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry

Top of Article

Introduction
Methods
Results
Discussion
Article Information
References

Table 1. Patient Sociodemographics, Technology Access, and PCP Factors by Interpreter Need
Table 2. Odds Ratios From Multivariable Model of the Association Between Patient’s Need for Language Interpreter and Video (vs Telephone) Telemedicine Visit
Reed
ME, Parikh
R, Huang
J, Ballard
DW, Barr
I, Wargon
C. Real-time patient–provider video telemedicine integrated with clinical care.  N Engl J Med . 2018;379(15):1478-1479. doi: 10.1056/NEJMc1805746 PubMed Google Scholar Crossref
Nouri
S, Khoong
EC, Lyles
CR, Karliner
L. Addressing equity in telemedicine for chronic disease management during the COVID-19 pandemic.  NEJM Catal Innov Care Deliv. 2020;1(3). doi: 10.1056/CAT.20.0123 Google Scholar
Ye
S, Kronish
I, Fleck
E,
et al. Telemedicine expansion during the COVID-19 pandemic and the potential for technology-driven disparities.  J Gen Intern Med . 2021;36(1):256-258. doi: 10.1007/s11606-020-06322-y PubMed Google Scholar Crossref
Zeigler
K, Camarota
S. 67.3 Million in the United States Spoke a Foreign Language at Home in 2018 . Center for Immigration Studies. 2019.
Nouri
SS, Avila-Garcia
P, Cemballi
AG, Sarkar
U, Aguilera
A, Lyles
CR. Assessing mobile phone digital literacy and engagement in user-centered design in a diverse, safety-net population: mixed methods study.  JMIR Mhealth Uhealth . 2019;7(8):e14250. doi: 10.2196/14250 PubMed Google Scholar

Academic Medicine
Acid Base, Electrolytes, Fluids
Allergy and Clinical Immunology
Anesthesiology
Anticoagulation
Art and Images in Psychiatry
Bleeding and Transfusion
Cardiology
Caring for the Critically Ill Patient
Challenges in Clinical Electrocardiography
Clinical Challenge
Clinical Decision Support
Clinical Implications of Basic Neuroscience
Clinical Pharmacy and Pharmacology
Complementary and Alternative Medicine
Consensus Statements
Coronavirus (COVID-19)
Critical Care Medicine
Cultural Competency
Dental Medicine
Dermatology
Diabetes and Endocrinology
Diagnostic Test Interpretation
Drug Development
Electronic Health Records
Emergency Medicine
End of Life
Environmental Health
Equity, Diversity, and Inclusion
Ethics
Facial Plastic Surgery
Gastroenterology and Hepatology
Genetics and Genomics
Genomics and Precision Health
Geriatrics
Global Health
Guide to Statistics and Methods
Guidelines
Hair Disorders
Health Care Delivery Models
Health Care Economics, Insurance, Payment
Health Care Quality
Health Care Reform
Health Care Safety
Health Care Workforce
Health Disparities
Health Inequities
Health Informatics
Health Policy
Hematology
History of Medicine
Humanities
Hypertension
Images in Neurology
Implementation Science
Infectious Diseases
Innovations in Health Care Delivery
JAMA Infographic
Law and Medicine
Leading Change
Less is More
LGBTQIA Medicine
Lifestyle Behaviors
Medical Coding
Medical Devices and Equipment
Medical Education
Medical Education and Training
Medical Journals and Publishing
Melanoma
Mobile Health and Telemedicine
Narrative Medicine
Nephrology
Neurology
Neuroscience and Psychiatry
Notable Notes
Nursing
Nutrition
Nutrition, Obesity, Exercise
Obesity
Obstetrics and Gynecology
Occupational Health
Oncology
Ophthalmic Images
Ophthalmology
Orthopedics
Otolaryngology
Pain Medicine
Pathology and Laboratory Medicine
Patient Care
Patient Information
Pediatrics
Performance Improvement
Performance Measures
Perioperative Care and Consultation
Pharmacoeconomics
Pharmacoepidemiology
Pharmacogenetics
Pharmacy and Clinical Pharmacology
Physical Medicine and Rehabilitation
Physical Therapy
Physician Leadership
Poetry
Population Health
Preventive Medicine
Professional Well-being
Professionalism
Psychiatry and Behavioral Health
Public Health
Pulmonary Medicine
Radiology
Regulatory Agencies
Research, Methods, Statistics
Resuscitation
Rheumatology
Risk Management
Scientific Discovery and the Future of Medicine
Shared Decision Making and Communication
Sleep Medicine
Sports Medicine
Stem Cell Transplantation
Substance Use and Addiction Medicine
Surgery
Surgical Innovation
Surgical Pearls
Teachable Moment
Technology and Finance
The Art of JAMA
The Arts and Medicine
The Rational Clinical Examination
Tobacco and e-Cigarettes
Toxicology
Trauma and Injury
Treatment Adherence
Ultrasonography
Urology
Users' Guide to the Medical Literature
Vaccination
Venous Thromboembolism
Veterans Health
Violence
Women's Health
Workflow and Process
Wound Care, Infection, Healing

Get the latest research based on your areas of interest.

Ris (Zotero)
EndNote
BibTex
Medlars
ProCite
RefWorks
Reference Manager
Mendeley

Disparities in Use of Video Telemedicine Among Patients With Limited English Proficiency During the COVID-19 Pandemic

1 Division of Research, Kaiser Permanente Northern California, Oakland
2 The Permanente Medical Group, Oakland, California

JAMA Netw Open. 2021;4(11):e2133129. doi:10.1001/jamanetworkopen.2021.33129

Reed
ME, Parikh
R, Huang
J, Ballard
DW, Barr
I, Wargon
C. Real-time patient–provider video telemedicine integrated with clinical care.  N Engl J Med . 2018;379(15):1478-1479. doi: 10.1056/NEJMc1805746 PubMed Google Scholar Crossref
Nouri
S, Khoong
EC, Lyles
CR, Karliner
L. Addressing equity in telemedicine for chronic disease management during the COVID-19 pandemic.  NEJM Catal Innov Care Deliv. 2020;1(3). doi: 10.1056/CAT.20.0123 Google Scholar
Ye
S, Kronish
I, Fleck
E,
et al. Telemedicine expansion during the COVID-19 pandemic and the potential for technology-driven disparities.  J Gen Intern Med . 2021;36(1):256-258. doi: 10.1007/s11606-020-06322-y PubMed Google Scholar Crossref
Zeigler
K, Camarota
S. 67.3 Million in the United States Spoke a Foreign Language at Home in 2018 . Center for Immigration Studies. 2019.
Nouri
SS, Avila-Garcia
P, Cemballi
AG, Sarkar
U, Aguilera
A, Lyles
CR. Assessing mobile phone digital literacy and engagement in user-centered design in a diverse, safety-net population: mixed methods study.  JMIR Mhealth Uhealth . 2019;7(8):e14250. doi: 10.2196/14250 PubMed Google Scholar
Get the latest from JAMA Network Open
Free access to newly published articles
To register for email alerts, access free PDF, and more
Get unlimited access and a printable PDF ($40.00)—
Sign in or create a free account
Free access to newly published articles
To register for email alerts, access free PDF, and more
Get unlimited access and a printable PDF ($40.00)—
Sign in or create a free account
Free access to newly published articles
To register for email alerts, access free PDF, and more
Free access to newly published articles
To register for email alerts, access free PDF, and more
Free access to newly published articles
To register for email alerts, access free PDF, and more
Create a personal account or sign in to:
Free access to newly published articles
To register for email alerts, access free PDF, and more
Create a personal account or sign in to:
Customize your JAMA Network experience by selecting one or more topics from the list below.
Hsueh L, Huang J, Millman AK, et al. Disparities in Use of Video Telemedicine Among Patients With Limited English Proficiency During the COVID-19 Pandemic. JAMA Netw Open. 2021;4(11):e2133129. doi:10.1001/jamanetworkopen.2021.33129
Telemedicine expands health care access for patients facing barriers to in-person care, 1 but may also inadvertently widen existing care disparities 2 , 3 for the 25 million people living in the US with limited English proficiency (LEP) 4 because of overlapping low digital literacy and health literacy. 5 Data on differential video vs telephone visit use by patients with LEP are needed to inform telemedicine equity strategies. In patients self-scheduling a primary care visit during the COVID-19 pandemic, we hypothesized that LEP would be associated with lower video use compared with telephone, especially among patients without prior video visit experience.
The retrospective cross-sectional study received institutional review board approval at Kaiser Permanente Northern California (KPNC) and waived informed consent because this was a data-only study with no participant contact. We followed the Strengthening the Reporting of Observational Studies in Epidemiology ( STROBE ) reporting guideline.
This study included all patient portal self-scheduled primary care telemedicine visits within KPNC from March 16 to October 31, 2020. In-person visits were only available by clinician recommendation after an initial telemedicine visit. Visits were accessible via any internet-enabled device. We extracted patient sociodemographics, technology access factors, and whether the patient visited their own primary care physician from automated data sources. Multivariate analyses examined the association between scheduling a video visit (vs telephone) and LEP, which was defined as needing an interpreter. An LEP × prior video visit interaction term was added to the multivariate regression to examine whether barriers to the initial video visit can potentially explain video visit use differences by LEP (ie, no video visit use differences by LEP among those with prior video visit use experience would suggest patients with LEP were not dissuaded by their initial video visit experiences).
We report adjusted video visit use frequencies generated from model coefficients for comparisons using Stata, version 14.2 (StataCorp LLC). Two-sided χ 2 tests were used to calculate P values for patient sociodemographics, technology access, and provider factors for interpreter need ( Table 1 ). Two-sided logistics regressions were used to calculate P values for odds ratios from multivariable model of the association between the patient’s need for a language interpreter and video vs telephone telemedicine visit. Statistical significance was set at P < .05. Data were analyzed between February and April 2021.
Among 955 352 primary care telemedicine visits (video: 379 002 [39.6%]; telephone: 576 350 [60.3%]) scheduled by 642 370 patients. There were 22 476 (2.4%) with EHR-documented interpreter need, 454 741 (47.6%) White patients, 216 788 (22.7%) Asian patients, and 196 483 (20.6%) Hispanic patients; 720 338 (74.5%) patients aged 18 to 64 years, 409 632 (42.4%) men, and 195 612 (20.2%) patients from low SES neighborhoods ( Table 1 ). Patients with LEP used video visits less frequently (7765 [34.5%]) than patients without LEP (371 237 [39.8%]). After multivariate adjustment, LEP vs no LEP was associated with lower video visit use (OR, 0.77; 95% CI, 0.74-0.80; adjusted video visit frequency of 34.7% for LEP vs 39.8% for no LEP) ( Table 2 ).
The association between LEP and visit type differed by prior video visit experience ( P < .001 for interaction). Simple effects tests and adjusted video visit frequencies showed that among patients without prior video visit experience, adults with LEP vs without LEP were less likely to use video visits (28.9% vs 35.9%; P < .001). However, among patients with prior video visit experience, adults with LEP did not differ from adults without LEP in their likelihood of choosing video visits (47.2% vs 49.1%; P = .09).
In this large, diverse sample of patients seeking primary care during the COVID-19 pandemic, one-third of patients with LEP scheduled a visit by video instead of telephone. Patients with LEP chose video less often than patients without LEP, even after adjusting for technology factors. However, among patients with video visit experience, no significant difference in video visit use by LEP was found, suggesting that once patients with LEP have video visit use experience, they are not different from patients without LEP in likelihood to reuse video visits. Although our analyses cannot determine causality, it is reasonable to hypothesize that helping adults with LEP overcome initial barriers to using video visits will result in more frequent future video visit use.
Our reliance on EHR-documented interpreter need as a proxy for LEP is a key study limitation. Nonetheless, with the rapid expansion and likely persistence of video telemedicine for delivering primary care, additional research is needed to identify barriers to initial video telemedicine use among patients with LEP.
Accepted for Publication: September 9, 2021.
Published: November 4, 2021. doi: 10.1001/jamanetworkopen.2021.33129
Open Access: This is an open access article distributed under the terms of the CC-BY License . © 2021 Hsueh L et al. JAMA Network Open .
Corresponding Author: Loretta Hsueh, PhD, Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612 ( Loretta.Hsueh@kp.org ).
Author Contributions : Drs Hsueh and Huang had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Hsueh, Parikh, Reed.
Acquisition, analysis, or interpretation of data: Hsueh, Huang, Millman, Gopalan, Teran, Reed.
Critical revision of the manuscript for important intellectual content: Huang, Millman, Gopalan, Parikh, Teran, Reed.
Statistical analysis: Hsueh, Huang, Reed.
Administrative, technical, or material support: Millman, Parikh, Reed.
Conflict of Interest Disclosures: Ms Millman reported receiving grants from the Agency for Healthcare Research and Quality during the conduct of the study. Dr Reed reported receiving grants from the Agency for Healthcare Research and Quality and the National Institutes of Health during the conduct of the study. No other disclosures were reported.
Funding/Support: Dr Hsueh reported receiving support from the The Permanente Medical Group Delivery Science Fellowship program. This study was funded by the Agency for Healthcare Research and Quality (grant R01HS25189).
Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

© 2023 American Medical Association. All Rights Reserved.
Terms of Use |
Privacy Policy |
Accessibility Statement

Reference #18.8c85655f.1678357457.abbe4d6

Одинокая молодая женщина показывает пизду крупным планом
Девушка насмотрелась порно журналов и трахнула себя пустой бутылкой
Лесбиянки фетишистки в латексный униформах медсестер

Галерея 2785802

Report Page