ID telehealth services expand, providing ‘viable alternative’ for care
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Telehealth services are expanding and providing an effective alternative for hospitals without access to infectious disease expertise, and they have improved patient no-show rates, according to data presented at IDWeek.
In one study, researchers reported a more than 400% growth over 6 years in inpatient ID telehealth consults at a rural Pennsylvania hospital. According to a second study in New York state, patients reported that telehealth visits during the early months of the COVID-19 pandemic were as satisfactory as in-person visits to the clinic.
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‘Viable alternative’
The first study “was prompted by a lack of data supporting whether or not a tele-ID-only service is a viable long-term solution for rural hospitals that have no prior access to ID care and if there is value in bringing tertiary care expertise at the community level,” Nupur Gupta, DO, MPH, clinical assistant professor at the University of Pittsburgh Medical Center, told Healio.
Gupta and colleagues collected longitudinal data from a 126-bed rural hospital in Pennsylvania that had no access to ID consultation before 2014. According to the study, live audio-video consults during business hours began in 2014 and telephonic physician-to-physician consults were made available 24/7.
The researchers extracted all electronic health records from between 2014 and 2019 and assessed outcomes including the number of consult encounters, total hospital length of stay (LOS), discharges to home, transfer to tertiary care centers and readmission rates at 30 days.
Overall, the number of unique consult encounters increased annually from 111 in 2014 to 469 in 2019, as did the Charlson Comorbidity Score and Elixhauser Comorbidity Index, which increased each year beginning in 2016.
According to the study, LOS decreased from 10.2 to 8.2 days, as did the 30-day readmission rate, by an average of 16.3% over 6 years. Additionally, most patients were not transferred (average 89.4% over 6 years) to tertiary care centers and more than half of patients (61.3%) were discharged to home each year.
During the study period, local physicians became more comfortable in retaining and managing complex patients with infections, Gupta said.
“Tele-ID is a successful and viable alternative modality to in-person care and should be strongly considered as a solution at facilities and in communities lacking ID specialty expertise,” she said.
Improves no-show rate
In the second study, researchers assessed telehealth services for general infectious diseases and HIV at the University of Rochester Medical Center.
“With the pandemic and the social distancing established at the end of February, hospitals and health care centers were committed to explore new alternatives to ensure patient care,” Karen L. Carvajal, MD, an infectious diseases fellow at the university, told Healio. “In this context, telemedicine has been raising and gaining a place in the care of patients, especially now that Medicare lifted its restrictions during the COVID-19 emergency regarding places, applications and the kind of providers that telehealth was conducted before.”
The new scenario “offered a unique opportunity, a historical moment, for evaluating the impact of telehealth in the delivery of health care in the general infectious diseases and HIV clinic.”
Carvajal and colleagues surveyed 260 patients who participated in telehealth visits for HIV or general infectious diseases. According to the study, the researchers collected information regarding the reason for the telehealth visits, access to technology, patient satisfaction and preferences over in-person visits. They also determined the rates of no-show visits and rates of compliance between in-between and telehealth visits.
The study demonstrated that 93.4% of patients with general infectious diseases and 84.3% of patients with HIV surveyed either strongly agreed or somewhat agreed that their telehealth visit was as satisfactory as a clinic visit. Additionally, 67.5% of patients with general infectious diseases and 63% of patients with HIV agreed that the option of telehealth would increase their compliance rate in the future.
The survey also revealed that the no-show rate during the telehealth period in the HIV group decreased from 23% to 5% compared with the previous year, whereas the no-show rate in the general infectious diseases group decreased from 9% to 4%.
“Telehealth can be used in the ID clinic for a variety of conditions, including acute or chronic health problems, laboratory and treatment monitoring and follow up after hospitalization. Both groups, despite the age, were able to use technology effectively and in a very comfortable way,” Carvajal said. “Telehealth demonstrates to be a very flexible tool.”
References:
Carvajal KL, et al. Oral Abstract 127. Presented at: IDWeek; Oct. 21-25, 2020 (virtual meeting).
Gupta N, et al. Oral Abstract 124. Presented at: IDWeek; Oct. 21-25, 2020 (virtual meeting).
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Gupta N, et al. Abstract 124. Presented at: IDWeek; Oct. 21-25, 2020 (virtual meeting).
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