BLOG: Telehealth utilization for transplant patients during COVID-19 pandemic

ByChristopher E. Dandoy, MD, MSc

BySamantha M. Jaglowski, MD, MPH

Thanks to the COVID-19 pandemic, it became necessary to rethink how complex care is delivered to immunocompromised patients.

It quickly became apparent that immunocompromised patients — including those who had received a hematopoietic cell transplant or engineered cell therapy — were at highest risk for developing severe complications if infected.

Therefore, it became necessary to explore ways to continue to provide excellent care while avoiding unnecessary exposures.

Relaxation of regulatory measures and changes in payment models allowed for the rapid expansion of telehealth as a care delivery method.

Christopher E. Dandoy

Studies began to suggest that telehealth could increase convenience and improve access to care, but concerns remained about the quality of care delivered via telehealth and the ability to connect with patients via a screen.

Given emerging literature and the changing treatment landscape, the ASTCT Quality Outcomes Committee set out to understand transplant providers’ experiences with telehealth and how this care modality could be used for transplant patients in a post-pandemic landscape.

A survey was circulated to ASTCT membership and response was voluntary. Targeted emails were sent to leadership of programs that did not have any initial respondents to ensure broad representation.

Samantha Jaglowski

Survey questions addressed demographics, telehealth experience and the telehealth usability questionnaire. Survey questions around which types of visits were appropriate for telehealth and preferences around care were developed by the authors and reviewed by the Quality Outcomes Committee.

Seventy-six individuals from 70 institutions completed the survey, including 56 physicians (74%). Respondents represented four continents: North America (67%), South America (28%), Europe (4%) and Asia (1%).

The majority of respondents did not use billable telephone or video visits before the COVID-19 pandemic (76%; n=54), whereas the majority of centers conducted billable telephone and/or video visits after the start of the pandemic (90%; n=68).

Fifty individuals (66%) stated they received training — in person, videos and/or written instructions — on how to perform virtual visits. With regard to computer literacy, 58 respondents (76%) indicated they felt somewhat to very comfortable with new technology.

The majority of respondents indicated patient safety was never (17%; n=13) or rarely (57%; n = 43) compromised. More than half (54%; n = 41) indicated that telehealth has positively impacted wait time for new visits, and one-third (33%) reported that telehealth did not impact wait time negatively or positively.

Similar to other surveys of oncology providers, we found that transplant providers felt that telehealth had its uses in transplant care, but that certain situations are more appropriate for a face-to-face visit.

Transplant providers were able to quickly adapt to new ways of delivering care. The evolving rules around licensure and reimbursement certainly will inform how telehealth develops, but it seems likely that it will continue to play an increasing role in the care of transplant patients.

Here is a detailed overview of the ASTCT telehealth survey results:

Question: Did you conduct billable, scheduled telephone or video visits before the COVID-19 pandemic?

No — 71% (n = 54)
Yes, telephone only — 3% (n = 2)
Yes, video only — 10% (n = 8)
Yes, telephone and video — 7% (n = 5)
No response — 9% (n = 7)

Question: Did you conduct billable, scheduled telephone or video visits after the start of the COVID-19 pandemic?

No — 4% (n = 3)
Yes, telephone only — 7% (n = 5)
Yes, video only — 18% (n = 14)
Yes, telephone and video — 65% (n = 49)
No response — 7% (n = 5)

Question: In a typical week at the height of the pandemic, what percentage of your patient encounters were video or telephone visits?

0 to 10% — 24% (n = 18)
11% to 20% — 8% (n = 6)
21% to 30% — 17% (n = 13)
31% to 40% — 13% (n = 10)
41% to 50% — 11% (n = 8)
51% to 60% — 3% (n = 2)
61% to 70% — 4% (n = 3)
71% to 80% — 9% (n = 7)
More than 80% — 4% (n = 3)
No response — 8% (n = 6)

Question: What is the most important factor in determining if a virtual visit is offered?

Provider discretion — 50% (n = 38)
Patient discretion — 20% (n = 16)
Cancer center policy — 15% (n = 11)
Other / no response — 15% (n = 11)

Question: How often have you had issues getting laboratory data in a timely manner?

Frequently — 3% (n = 2)
Often — 16% (n = 12)
Sometimes — 38% (n = 29)
Rarely — 25% (n = 19)
Never — 5% (n = 4)
No response — 13% (n = 10)

Question: How often have you had to have additional visits with a patient because labs or imaging were not done in a timely or appropriate manner?

Frequently — 0
Often — 3% (n = 2)
Sometimes — 28% (n = 21)
Rarely — 42% (n = 32)
Never — 15% (n = 11)
No response — 13% (n = 10)

Question: How has your patient satisfaction been impacted by the use of telehealth?

Very positively — 26% (n = 20)
Somewhat positively — 37% (n = 28)
Neither positively nor negatively — 21% (n = 16)
Somewhat negatively — 3% (n = 2)
Very negatively — 0
No response — 13% (n = 10)

References:

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Sources/Disclosures

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Disclosures: Dandoy and Jaglowski report no relevant financial disclosures.