telehealth for vulnerable populations...gregory m. blumenthal, phd, gmbs consulting telehealth...
TRANSCRIPT
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Telehealth for Vulnerable Populations
Delivering telehealth to underserved/vulnerable client populations-
best practices
June 2, 2020
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PANELISTS
Rosie Phillips Davis, PhD, ABPP
Larita Taylor, PhD, MPH, CLC.Espi Ralston, MA, MAT, MA, CMI-Spanish,
CHTM
MODERATORMarian Levy, DrPH, RD, FAND
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Rosie Phillips Davis, PhD, ABPP
Delivering Telehealth Services to the Underserved
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2019 Memphis Poverty Fact Sheet (Data from 2018 ACS)
• 2019 Overall White Black Latino Asian
• (Non-Hispanic)
• U.S 12.3% 8.7% 21% 18.3% 10.0%
• TN 11.5% 9.3% 18.6% 24.4% 7.7%
• S.C. 21.7% 8.6%. 30.5% 24.0% N/A
• Mem 27.8% 11.8% 33.8% 28.8% N/A
(Fox News Report could be 50% this year)
© 2019 Poverty Fact Sheet. Elena Delavega, PhD, MSW, School of Social Work, University of Memphis, & Gregory M. Blumenthal, PhD, GMBS Consulting
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Telehealth Without Broadband?
• Of the 256,973 households in Memphis in 2016, 126,428 of them had no broadband connection.
• South Memphis 80% without Broadband
• Frayser 60% without Broadband
• 44.9% Of Memphis Children live in Poverty
National Digital Inclusion Alliance (2018) https://www.memphisflyer.com/memphis/poverty-in-a-pandemic/Content?oid=22903840
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Covid 19 and African Americans
• In Shelby County
• 52% 0f the Population/69% of Covid-related Deaths
• In Tennessee
• 17% of the Population/33% of the Covid-related Deaths
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Kinds of Mental Health Issues
Grief, Anxiety, Depression
Decision Making during scarcity
Self-Efficacy and self-esteem around
technology
Guilt around teaching their
children
Stress from childcare and doing regular job
Isolation
Food insecurity Distrust of people and systems
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The 3 Ts of Intervention
TRUST TIME TECHNOLOGY
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Consider
• Religion and Faith (pro and con)
• Get Educated about the population—Drive through the neighborhood
• Problem solve with the Client
• Be aware of changes in the dynamic in the room (if another person enters)
• Talk about Covid 19 and its impact
• Telephone
• Build The RELATIONSHIP
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Building Rapport during Telehealth Visits
Larita Taylor, PhD, MPH, CLC
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Building Rapport Overview▪ 5 C’s of Establishing Good Rapport (Context, Comfort, Consent,
Collaboration & Compliance)
▪ Encouraging Patient Feedback
▪ Resources
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Unscientific PollWhich posthumously published book would best describe your PRIMARY challenge during the COVID-19 Pandemic?
A. To Zoom or Not to Zoom That is the Question by William Shakespeare
B. I know Why the Caged Child Screams by Maya Angelou
C. Tiger King de Oklahoma by Miguel de Cervantes
D. Telehealth Here, Telehealth There, Telehealth Everywhere by Dr. Seuss
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ContextTelehealth Here, Telehealth There, Telehealth Everywhere
Telehealth in a hospital room, Telehealth on Zoom
Telehealth on the phone, Telehealth at home
Telehealth insurance cap, telehealth smart phone app
Telehealth where kids loom, Telehealth sound on boom
Telehealth on hospital cot, Telehealth diagnostic robot
Telehealth here, Telehealth there
We can do Telehealth everywhere
Just don’t forget the Telehealth standard of care!
-In the Spirit of Dr. Seuss
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Comfort▪ Navigating Technology
▪ Secure Internet Connection
▪ Noise Reduction
▪ Lights! Camera!... Room
▪ Laymen’s Language:
Blood Sugar vs Glucose, High Blood Pressure vs. Hypertension
(photo credit HF SIG, 2017)
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Consent
▪ Introduce yourself
▪ Written consent vs. Oral Consent
▪ Give overview of session
▪ Ask for permission to investigate
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Collaboration
▪ Encourage patient-led problem solving
“Were there any changes in your usual routine that may have caused your blood pressure to be higher than normal?”
▪ Empower patient with self-monitoring skills/resources
“Would you be willing to keep a food log so you can see if your blood sugar raising after you eat certain foods?”
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Compliance
▪ Create an action plan
▪ Assess barriers to implementation
“Will you be able to pick up your prescription within the next two days?’
▪ Get agreement
▪ Ask patient to restate/ summarize the action plan
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Encourage Patient Feedback
• Before session ends
• Complete reviews within the platform (if applicable)
• Reviews on websites, i.e. health grades, vitals, etc.
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Resources▪ Centers for Medicare & Medicaid Services (2020) Medicare
Telemedicine Healthcare Provider Fact Sheet
▪ American Telemedicine Human Factors SIG (2017) Let there Be Light: A quick guide to telemedicine lighting
▪ Olson, C. A., McSwain, S. D., Curfman, A. L., & Chuo, J. (2018). The current pediatric telehealth landscape. Pediatrics, 141(3), e20172334.
▪ Stewart, E. E., & Fox, C. H. (2011). Encouraging patients to change unhealthy behaviors with motivational interviewing. Family practice management, 18(3), 21.
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Delivering Telehealth
Services to the Latino
PopulationEspi Ralston, MA, MAT, MA, CMI-Spanish, CHTM
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Bridging Languages and Cultures
“
Access with Dignity
© 2003 Kaiser Permanente, National Diversity - National Linguistic & Cultural Programs
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Every medical encounter
is a cross-cultural
encounter.
INTERCULTURAL, TRANSCULTURAL
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What’s Visible?Iceberg
Analogy
attitudes sexual
orientation
traditionsbeliefs
values
age gender
income
racephysical
abilities
marital
status
Cultural Artifacts
(e.g., fashion, popular culture)
Cultural Assumptions
© 2003 Kaiser Permanente, National Diversity - National Linguistic & Cultural Programs
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Personality
Age
Religion/
Spirituality
Recreational
Habits
Personal
Habits
Income
Gender
Sexual
Orientation
Physical
AbilityEthnicity
Race
Educational
Background
Work
Experience
Appearance
Parental
Status
Union
Affiliation
Management
Status
Functional Level/
Classification
Geographic
Location
Work Content/
Field
Marital
Status
Work
Location Seniority
Division/
Dept./
Unit/
Group
Source: From Diverse Teams. Lee Gardenswartz and
Rowe. Burr Ridge, IL: Irwin Professional, 1994.
Used with permission. Note: Internal Dimensions and
External Dimensions are adapted
from Marilyn Loden and Judy Rosener, Workforce
America! Burr Ridge IL: Irwin Professional, 1991.
Div
ers
ity
Wh
ee
l Internal Dimensions
Organizational Dimensions
External Dimensions
© 2003 Kaiser Permanente, National Diversity - National Linguistic & Cultural Programs
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Telehealth Challenges
LEP, NEP client, patient? = Interpreter needed
Client unfamiliar with the provider (+interpreter)
if first visit
Spatial configuration (distancing = intimidating)
Difficulty in establishing proximity
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First phase: Setting the tone
Importance of rapport building and
agenda setting to identify and prioritize
issues to address during the visit
How to build a good rapport?
Creating a culturally appropriate
atmosphere.
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Setting the Tone (Rapport Phase)
“I know that different people have different ways of
understanding illness. Please help me understand
how you see things.”
“I want to understand the problems that bring you
here today so that I can help you efficiently.”
Genuine interest in the patient may lead to …….
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Trust and Respect
Confidentiality and privacy (taboos,
stigmas,”dirty laundry kept at one’s
home.”)
Familiarize with patient’s medical
protocols expectations
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Trust, Respect = Loyalty to provider
Patient’s Expectations:
Not to be rushed by the provider. May deviate
or extrapolate from main reason of visit. Expects
a longer visit.
Formal greetings (respect) vs informal
Provider looking at the patient directly.
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Familialism = Family comes first.
Acculturation level: Information withheld from the
patient by family members or by the own patient.
Important decisions may require consultation
among entire family. IILLNESS = SOCIAL CRISIS
Psychological difficult for family to hand over care
of ill member to non-family health provider.
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Patient’s Comments
”Antes de mi cita, que el médico se tomara el tiempo de leer mi historial médico”.
“Que esté en un sitio en su oficina sin ninguna distracción y enfocado en mi cita, sin ninguna distracción”.
“Que durante la cita, esté atento a lo que yo tenga que decir y explicar.”
“Que me explique lo que piensa de mis síntomas de manera claray precisa y que no me vea como un número más”.
“Que esté abierto a mis preguntas y me explique el tratamiento y sus expectativas del progreso de mi caso”.
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Patient’s Comments
“Que no ande con prisas”.
“Que no me trate con condescendencia.
“Que no me trate con una actitud de
superioridad”.
“Que se cerciore de que entendí y que
no tengo más preguntas”.
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Bridging Languages and Cultures
“
Access with Dignity
© 2003 Kaiser Permanente, National Diversity - National Linguistic & Cultural Programs
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Telehealth for Vulnerable Populations
Delivering telehealth to underserved/vulnerable client populations-
best practices
June 2, 2020