24-hour helpline supports patients with food allergy on oral immunotherapy
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Key takeaways:
- An expert is available by phone 24/7 to answer questions about oral immunotherapy.
- Patients were 3.6 times more likely to call during the updosing phase compared with the maintenance phase.
Patients on oral immunotherapy for food allergy were satisfied with a 24/7 telephone helpline that provided support for their treatment, according to a letter published in Clinical and Translational Allergy.
The helpline also encouraged adherence and compliance, Antonella Muraro, MD, PhD, head of the Food Allergy Referral Centre, Veneto region, department of women and children health, Padua University Hospital, and colleagues wrote.
“The COVID-19 pandemic led to an unprecedented change in clinical procedures, motivating physicians and health care systems worldwide to rapidly implement telemedicine programs to reduce or replace in-person visits,” Muraro told Healio.
Telemedicine was widely used in allergy and in oral immunotherapy in particular for the first time during the pandemic, she continued.
“Our study aimed to evaluate patients’ and parents’ opinions and satisfaction about an expert support telephone line accessible 24 hours a day dedicated to patients undergoing OIT during the first year of the pandemic in Italy, when face-to-face support was less accessible,” Muraro said.
The study also allowed the researchers to evaluate the potential implementation of novel, more tailored and effective interventions in the post-pandemic era, she said.
Study design, results
In 2011, the Food Allergy Referral Centre established a helpline staffed by experts around the clock for patients treated with OIT. However, the COVID-19 pandemic prompted significant growth in the use of telemedicine, including allergy care.
“The 24-hour service is guaranteed by shifts between allergists of the unit who know the patients and have specific training and experience in the field of food allergies, anaphylaxis and oral immunotherapy,” Muraro said. “Clinicians of the Food Allergy Centre serve, however, on a voluntary basis for the helpline.”
The researchers then aimed to evaluate the attitudes of patients and of the parents of patients toward the helpline during the first year of the pandemic in Veneto, while understanding their needs and how the hotline benefitted them.
In March 2021, the researchers administered an online survey to 65 parents of patients and 20 adult patients (83% female). The patients (57% male) had a mean age of 15 years (standard deviation [SD], 8.22).
Allergens treated in OIT included milk (n = 58; 68.2%), egg (n = 23; 27.1%) and wheat (n = 4; 4.7%). Also, 56 of the patients (68%) were in the updosing phase and 29 (34.1%) were in the maintenance phase.
During the previous 12 months, 54% of the patients called the helpline at least once. These calls included 36 (78%) in the updosing phase (mean number of calls, 1.2; SD, 1) and 10 (22%) in the maintenance phase (mean number of calls, 0.69; SD, 1).
Also, patients in the updosing phase were 3.6 times more likely to call than those in the maintenance phase (95% CI, 1.1-12.2).
The most common reasons for calling the helpline included “clarifications” (69.6%), “mild/moderate allergic symptoms” (56.5%), “reassurance” (34.8%) and “ongoing anaphylaxis” (11.1%).
Without the helpline, the patients further reported, 48.9% would have gone to see their physician, 37.8% would have gone to the hospital, 26.1% would have taken some other action, 8.9% would have waited for their next appointment and 2.2% would have done nothing.
“This underlines the need for overall care, especially during the initiation phase of OIT,” Muraro said.
The survey also asked six questions pertaining to satisfaction with the helpline rated on a scale of 1 to 5, with responses of 1 indicating “not at all” and 5 indicating “extremely.” Mean totals included:
- Were your questions answered well: 4.93 (SD, 0.33).
- Was the advice given helpful: 4.93 (SD, 0.33).
- Did you follow the advice: 4.96 (SD, 0.21).
- Did you feel more confident in dealing with the issue about which you rang: 4.91 (SD, 0.29).
- Would you ring the helpline again: 5 (SD, 0.01).
- Overall, how valuable to you is the helpline service for OIT patients: 5 (SD, 0.01).
The mean satisfaction global score was 4.96 (SD, 0.18). The reliability for these satisfaction scores was excellent (alpha, 0.94), the researchers said, with Spearman correlations between items ranging from 0.82 to 0.97 as well as a strong correlation between items and composite satisfaction (P < .001).
Also, the researchers said, the significant regression model (F = 5.27; P < .001) indicated that the number of calls predicted satisfaction (B = 0.14; 95% CI, 0.1-0.23).
Conclusions, next steps
Based on these findings, the researchers said that telehealth may present a resource-friendly method for ensuring that families are safely monitored while providing continuing support and education and addressing parental and patient concerns.
Muraro cautioned that the researchers did not have any data about patient experiences with the helpline before the pandemic.
“However, looking at the opinions expressed by patients involved in the study, it was clear that the helpline has been experienced by patients as a crucial support in absence of an in-person evaluation,” she said.
Additionally, she continued, the helpline saved time and resources for physicians.
The researchers further noted that such support is essential in maintaining safety and long-term success. As the helpline quickly addresses concerns about side effects and related issues, the researchers said, it may facilitate adherence and minimize hospital use, although more research would be necessary.
“Patients and caregivers appear to live in a continuous uncertainty with a need to be often reassured, especially during the initiation phase of OIT, but also during its maintenance,” Muraro said.
The helpline properly addresses patient and caregiver concerns when reactions happen, promotes effective management of these reactions and adherence to treatment, and ultimately reduces the need to go to the hospital, Muraro said.
“The use of telehealth services may be key to long-term success of food immunotherapy, allowing support from clinicians for immediate, individual patient issues,” she said. “Furthermore, results may indicate when support during OIT is needed most, helping us to pinpoint the optimum time to prevent dropout or lack of satisfaction with treatment.”
The researchers called for wider integration of these services on a permanent basis for food allergy treatment, including OIT, better promoting the continuity and safety of care.
Muraro said other OIT providers can replicate the helpline with a dedicated number provided to patients and caregivers when treatment begins in their own practices.
In addition to training and experience in food allergies, anaphylaxis and OIT, Muraro said that the staff answering calls at the helpline also should know their patients and have their trust while exhibiting good communication and interpersonal skills.
The researchers will continue to evaluate the helpline’s performance.
“The next step is to evaluate the cost-effectiveness of the helpline as well as to compare the data in a post-pandemic era in order to integrate and enhance telehealth on a more permanent basis,” Muraro said.
For more information:
Antonella Muraro, MD, PhD, can be reached at muraro@centroallergiealimentari.eu.