Telemedicine increases access to allergy care, but some hurdles remain
Click Here to Manage Email Alerts
Pediatric allergy clinics can use telemedicine to increase accessibility, with subsequent in-person visits scheduled for necessary testing, according to a study published in The Journal of Allergy and Clinical Immunology: In Practice.
However, barriers to telemedicine care remain and need to be researched and addressed, according to Suzanne Y. Ngo, MD, an instructor in the department of pediatrics at University of Colorado School of Medicine, and colleagues .
“Due to the need to switch exclusively to telemedicine in the spring of 2020 with the onset of the COVID-19 pandemic, we were interested to look at outcomes of the care we provided through telemedicine,” Ngo told Healio.
“It seemed clear telemedicine would still be utilized in health care beyond the pandemic, so we wanted to evaluate what we could learn from our experiences during this period to help improve how we can continue to deliver care in an allergy clinic via telemedicine,” she said.
The researchers examined the telemedicine encounters scheduled from April 1 to April 30, 2020, at the Children’s Hospital Colorado Pediatric Allergy Clinic. They also reviewed in-person encounters from April 2019 as a pre-pandemic baseline.
If needed, in-person testing visits began May 11, 2020. Clinic nurses performed skin prick testing and respiratory therapists performed spirometry during nursing-only encounters, and labs were completed in the walk-in outpatient laboratory.
The clinic scheduled 365 patients and completed 315 telemedicine encounters (86.3%) in April 2020, compared with 377 scheduled patients and 260 completed in-person encounters (69%) in April 2019.
Noting the better show rates in 2020 (P < .001), the researchers said that telemedicine may be more accessible for certain patients for outpatient encounters.
“In the study, we were unable to evaluate the degree of technology accessibility among our patient population,” Ngo said.
“However, this is also expected to be an important barrier to improved access. This can directly be associated to language if the interface for patients to access these virtual visits is not available in their preferred language,” she said.
Compared with the in-person cohort, the telemedicine cohort included fewer patients who identified as Hispanic or Latino (32.4% vs. 24.4%; P = .019) and fewer patients reporting a primary language other than English (10.4% vs. 3.9%; P = .036).
The researchers further reported limited availability of interpreter services in April 2020 and significantly less interpreter utilization compared with April 2019 (0.6% vs. 10.4%; P < .001), indicating a need for robust interpreter services to facilitate telemedicine.
Also, the researchers found no significant differences between April 2019 and 2020 in primary visit diagnoses. However, clinicians recommended in-person testing during 152 (48.3%) telemedicine visits, compared with during 207 (79.6%) visits in 2019 (P < .001).
Compared with the in-person visits, less testing was ordered during the telemedicine visits for “food allergy or other adverse food reaction” (92.1% vs. 61.5%; P < .001), “eosinophilic gastrointestinal disease” (92.3% vs. 28%; P < .001) and “asthma or other respiratory disorders” (86.5% vs. 47.3%; P < .001). In-person new patient visits saw more testing orders for “atopic dermatitis or other rash” as well (75% vs. 43.5%; P = .037).
Follow-up visits saw even more pronounced differences, which may reflect urgent testing that was performed more often during in-person visits, the researchers said. Also, they continued, testing for dermatologic complaints may not be as urgent.
Patients in the in-person cohort completed 95.6% of their recommended tests, whereas the telemedicine cohort only completed 66.8% (P < .001), with lower rates of testing ordered and completed for SPT, spirometry and labs.
The researchers attributed these differences to more judicious testing recommendations from allergy care providers as the need for additional encounters for patients to complete testing would reduce completion rates. Patient hesitancy due to the COVID-19 pandemic may have magnified these differences as well, the researchers added.
There were no significant differences in the proportions of ordered food challenges (10.5% for telemedicine vs. 15.4% for in-person), but the telemedicine cohort completed fewer of these challenges (63.6% vs. 87.5%; P = .016).
Food challenges were conducted as separate visits in both cohorts, the researchers wrote, so these differences are likely due to the COVID-19 pandemic as well. In contrast, there may be less perceived urgency for drug challenges, leading to similar orders and completion in both cohorts.
Overall, 51.7% of the patients in the telemedicine cohort did not require any additional in-person testing, making them the preferred group to target for telemedicine management, the researchers wrote. When testing is required, the researchers continued, testing-only appointments can be used with adequate completion rates.
“It was expected that because patients were asked to return at a separate time to get in-person testing, such as allergy skin testing or lung function testing, that there would be lower rates of testing completion,” Ngo said.
“However, in cases where the testing is needed more urgently to allow for prompt patient treatment, rates of completion were not significantly lower than in patients who had in-person clinic visits. This gives us more confidence that we can still provide appropriate care for our patients even with an initial virtual encounter,” she said.
Looking ahead, Ngo noted that even though there are limitations during telemedicine encounters, asynchronous testing options can be employed successfully. She also said that research into best practices should continue.
“It would be important to evaluate telemedicine outcomes outside the setting of the COVID-19 pandemic to ensure this is a sustainable approach to treating patients,” she said.
For more information:
Suzanne Y. Ngo, MD, can be reached at suzanne.ngo@childrenscolorado.org.
Perspective
Back to Top
I’m not surprised at all by these results, as they reflect what other similar studies and our own experiences have shown. I think these findings are very significant as prior to the pandemic, many allergist offices were not using telemedicine in any manner, including our own. Now, almost all of us have been able to implement it in some fashion, which has been very useful for our patients.
We had an almost identical experience during the time period when this study took place. In the early stages of the pandemic, we shifted completely to telehealth visits. We have since resumed in-person services while keeping patient and staff safety at the forefront and still allowing for use of telemedicine when applicable.
It will be useful to monitor the use of telemedicine over time, particularly as the pandemic hopefully shifts more toward endemic status. Telemedicine can become a useful part of clinical practice, but we’ll have to continue to learn about barriers and best practices.
Doctors who would like to improve their own use of telemedicine can refer to the robust resources available through the American College of Allergy, Asthma and Immunology and the American Academy of Allergy, Asthma & Immunology. Both organizations have really created remarkable resources to help clinicians and patients utilize telemedicine in the most productive manner.
Collapse
Read more about
Click Here to Manage Email Alerts