Telemedicine saves time, money in penicillin allergy de-labeling
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Key takeaways:
- 55% of patients strongly agreed they were very satisfied with their encounter.
- Telemedicine saved 123 minutes of allergist time.
- Cost savings were approximately $510 per patient.
SAN ANTONIO — Providers can use telemedicine to conduct penicillin and other drug allergy screenings, saving time and costs, according to data presented at the American Academy of Allergy, Asthma & Immunology Annual Meeting.
“Telemedicine is a way for us to spread our tentacles a little bit and improve our reach,” Allison C. Ramsey, MD, FACAAI, FAAAAI, clinical assistant professor of medicine, University of Rochester, said during her presentation.
There are between 25 million and 30 million patients with a reported penicillin allergy in the United States, according to Ramsey, who also is a member of the Healio Allergy/Asthma Peer Perspective Board.
“It’s no secret that it is the most common drug allergy recorded in the U.S.,” Ramsey said.
Yet less than 0.1% of these patients ever have their allergy evaluated, she continued.
“That’s because there’s not that many of us practicing allergy/immunology in the U.S.,” she said.
Specifically, Ramsey noted that there are fewer than 5,000 allergists in the United States and that allergy primarily is an outpatient specialty with high rates of reported penicillin allergies among inpatient populations.
“We know that we can make the most impact with penicillin allergy on the inpatient side,” she said. “We know there’s more benefit to de-labeling on the inpatient side, but we’re not there.”
Telemedicine can serve as a bridge between the outpatient and inpatient settings to de-label the patients who need it the most, she said, adding that she has seen an increase in penicillin allergy awareness during her practice. Plus, she said, physical exams are not necessary for de-labeling unless patients are having acute reactions.
“Pre-pandemic, we actually instituted penicillin and other drug allergy evaluations via telemedicine at our hospital,” Ramsey said, adding that she and her team have since improved their approach.
At Rochester Regional Health, the consult for a penicillin allergy is placed through the electronic health record. The allergist then speaks to the team through the office. An advanced practice provider next takes the patient history, conducts skin testing if indicated, and contacts the allergist via Skype for Business.
“Our hospitals are hardwired with that,” Ramsey said.
Finally, there is a virtual visit between the allergist and the patient, with the advanced practice provider present as well.
Ramsey and her colleagues reviewed this approach with 338 screened patients, including 226 who were excluded prior to the interview. These patients included:
- 108 who were discharged prior to consenting;
- 32 who were unable to consent;
- 28 whose antibiotics were discontinued prior to consenting;
- 23 who received or tolerated a penicillin-like antibiotic;
- 17 whose primary team declined penicillin skin testing;
- 11 whose intolerance had been documented as an allergy;
- four with a high-risk presentation;
- two who were pregnant; and
- one with a family history documented as an allergy.
The team then approached the remaining 112 patients, with 62 more excluded after the interview, including 47 who declined penicillin skin testing and 15 who described a non-IgE history.
“Some are like, ‘I’m going to cling to my penicillin allergy and decline testing.’ Some were inappropriate for testing. But we ended up testing 50 people, and, again, interviewing them via telemedicine,” Ramsey said.
Two patients (4%) said their overall impression of telemedicine consults for penicillin skin testing was fair, three (6%) said it was neutral, 18 (37%) said it was good and 26 (53%) called it excellent. The average rating was 4.4 on a Likert scale of 1 to 5.
Also, patient satisfaction was generally positive. When asked if they were very satisfied with their telemedicine encounter, one patient (2%) was neutral, 21 (43%) agreed and 27 (55%) strongly agreed. The average rating was 4.5 on the Likert scale.
The team also presented patients with the statement “I would have preferred to discuss penicillin skin testing with the doctor in person,” with six (12%) strongly disagreeing, 11 (22%) disagreeing, 26 (53%) neutral, four (8%) agreeing and two (4%) strongly agreeing. The average Likert scale rating was 2.7.
“I think that’s notable that we can do this and still be doing the other part of our job in the outpatient side and we’re not diminishing patient satisfaction,” Ramsey said.
The program also saved $360 per patient among 33 patients due to the changes in antibiotics, as well as time.
“I think time is pretty precious,” Ramsey said. “Our office is at least 10 to 15 minutes away from our hospital, no matter which office I’m at.”
The program saved 123 minutes of each allergist’s time, with each allergist spending an average of 5 minutes of face time with each patient. The time saved means more money saved too.
“So, this is a very conservative cost savings estimate of $510 per patient,” Ramsey said.
Additionally, Rochester Regional Health employed telemedicine to de-label drug allergies in a pediatric cystic fibrosis clinic that included allergists and immunologists among its interdisciplinary team due to the high risk for drug allergies among these patients.
“There were some days that the allergy/immunology physicians couldn’t be present at this specialty clinic, so they could do a telemedicine encounter with these patients to triage their drug history,” Ramsey said.
Among 26 patients with at least one allergy encounter, six patients were evaluated based on a history evaluation via telemedicine.
“This is an example of using telemedicine as a multidisciplinary approach to high-risk groups,” Ramsey said. “But you could easily use this in other high-risk groups, like hematology/oncology or obstetrics.”
Considering the patient satisfaction as well as the cost and time savings, Ramsey encouraged other allergists to engage in telemedicine for drug allergy evaluations.
“You can use a telemedicine encounter as a way to increase your presence at your hospital or to help a rural hospital,” she said. “This is a way to increase our reach and our presence and also increase your patient base, because these patients follow up.”