Telemedicine journal and e-health : the official journal of the American Telemedicine Association
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Observational Study
Telehealth Decreases Rural Emergency Department Wait Times for Behavioral Health Patients in a Group of Critical Access Hospitals.
Background: Telehealth has been proposed as an important care delivery strategy to increase access to behavioral health care, especially in rural and medically-underserved settings where mental health care provider shortage areas predominate, to speed access to behavioral health care, and reduce health disparities. Introduction: This study was conducted to determine the effects of telehealth-based care delivery on clinical, temporal, and cost outcomes for behavioral health patients in rural emergency departments (EDs) of four Midwestern critical access hospitals (CAHs). Materials and Methods: Observational matched cohort study of adult (age ≥18 years) behavioral health patients treated in participating CAH EDs from 2015 to 2017 (N = 287). Telehealth cases were matched 2:1 retrospectively to nontelehealth control cases based on gender, age ±10 years, diagnosis group, and CAH, before implementation of telehealth in the rural hospitals (2005-2013; N = 153). Results: The greatest number of behavioral health cases evaluated was in the mood, anxiety, and other mental health disorders category. The majority of patients in the telehealth (74%) and nontelehealth (68%) cohorts were 18-44 years. ⋯ Similar to recent studies, the most common behavioral health cases involved mood and anxiety disorders. Costs related to treatment were highest for substance abuse-related cases, likely due to the additional interventions needed, especially related to resuscitation There are opportunities to improve ED efficiencies and post-telehealth visit protocols related to the timeframe extending from the EOTVtD from the ED, which continues to be a focus of future research. Additional research is also needed to determine if telehealth lends itself more effectively to specific categories of behavioral health cases.
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Study Objective: Pain management in emergency department (ED) patients is challenging. Although both pharmacological and nonpharmacological therapies exist, they are often suboptimal. Immersive virtual reality (VR) uses distraction and possible other methods to reduce perceptions of pain. ⋯ Linear regression analysis revealed that patients with higher levels of health/quality of life (QOL) had larger mean drop per unit predictor for anger (0.29 [0.09], p = 0.0013) and anxiety (0.22 [0.07], p = 0.001). Conclusions: VR applications are feasible for ED patients and may lead to reduced pain, anger, and anxiety levels. These outcomes are affected by subject ethnicity, educational status, and health/QOL although independent of the chief complaint.