Telehealth increases show rates for asthma visits
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The prevalence of children who showed up to their asthma checkups increased with the use of telehealth during the COVID-19 pandemic, according to recent data.
The results were presented during the virtual American College of Allergy, Asthma and Immunology Annual Scientific Meeting.
Kenny Kwong, MD, and Lyne Scott, MD, run the LAC+USC Breathmobile program, a mobile asthma disease management system that delivers care to inner-city children at their schools in the Los Angeles Unified School district. When these schools were forced to close because of the COVID-19 pandemic, Kwong said the team “had to transition from face-to-face visits to an alternative method of patient care and encounter almost overnight.”
“Telemedicine was the most logical choice,” he told Healio Primary Care.
Providers and nursing staff had to overcome several barriers to adapt to the new platform, Kwong said. Nursing staff, for example, had to create a new schedule for telehealth visits, working around patients’ virtual school schedules. The nursing staff reported an increased workload during this initial phase of telehealth implementation, Kwong said.
In addition, providers had to work with specialist nurses to plan a schedule for patient education, which was previously done in the clinic after an in-person visit. They also had to adjust to a new charting and documentation system.
“These issues were resolved with providers and staff keeping open channels of communication and maintaining a degree of flexibility,” Kwong said. “There were initially twice-daily huddles with providers and staff. Ongoing experience resulted in new suggestions and improvements, which were quickly implemented.”
The researchers collected and analyzed data before and after the implementation of telehealth to assess how the abrupt transition from in-person to virtual visits affected “show rates” — the rate of patients who show up for their checkup — and disease control.
Kwong and Scott reported that show rates were significantly higher with telehealth compared with face-to-face visits. Providers and nursing staff reported a 32% to 62% increase in time spent with each patient during telehealth vs. in-person visits.
The researchers also found that more than 90% of patients had maintained asthma control during the pandemic. This prevalence was similar to the prevalence of asthma control during the same time period in 2019, the researchers said.
“It’s reassuring and encouraging that the quality of care of young patients, including those in underserved populations, received via virtual access kept their asthma under control,” Scott said in a press release. “This study shows it’s possible to move towards new models of treatment that increase access and convenience for the patient, and still maintain quality of care.”
Perspective
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This has been exactly my experience with a totally different population. I live in Montgomery, Alabama. I probably serve as rural a population as any allergist, whereas the physicians from this study in Los Angeles see an urban population. We set aside special appointment times for our Medicaid patients. Their show rate is typically in the neighborhood of 30% to 40%. However, we have been measuring it since we switched over to telemedicine for the COVID-19 crisis and have seen an increase that is very similar to this study.
The implications of this are huge. I’m very thankful that CMS and HHS have allowed us to conduct telemedicine and telephone visits during the crisis, and that they have extended this until the end of 2021, at least for Medicare patients. Hopefully, that will be extended to other patients. However, CMS and HHS say they can’t do this forever and that Congress has to act.
The other implication of this study is regional differences in broadband. I’m sure the broadband is very good in California, but if you are about 30 miles from my office, I really can’t do a telemedicine visit because of the inadequate internet access. I can, however, do a telephone visit. This highlights the need for better access to broadband in a lot of rural parts of the United States. If we are not going to have that, then we need parity in terms of payment and access to care for telephone visits.
I think the genie has come out of the bottle on this one. The rules that are set up by the federal government are so archaic. We just can’t go back to the way things were in 2019 for telemedicine — there have to be changes. I do a lot of advocacy work. Those of us who are in the house of medicine, regardless of specialty, need to petition the government to act. I think we can expect to see the AMA lead the way on this. The president of the AMA is an allergist and a friend of mine, and I can assure you that it is a goal of hers and the AMA to continue to increase access to telemedicine so that we can continue to see results like in this study. By no means is this an aberration. This is a universal experience that we’re seeing, at least in the specialty of asthma care.
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Kwong K, Scott L. Abstract A060. Presented at: ACAAI Annual Scientific Meeting; Nov. 13-15, 2020; Virtual.
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