key: cord-0701079-bd31vmsn
authors: Ramsey, Allison; Mustafa, S. Shahzad
title: Reply to Appointment Characteristics during COVID-19 Restrictions – A Canadian Allergy/Immunology Centre Perspective
date: 2020-07-18
journal: J Allergy Clin Immunol Pract
DOI: 10.1016/j.jaip.2020.06.068
sha: 827348abf7d9763da2bfa2dfc98b3f836374f32b
doc_id: 701079
cord_uid: bd31vmsn

nan

To the Editor: 25 We appreciate the data provided by Zhu et al. regarding their experience among 2 academic 26 allergists in Canada from March 16-May 1 2020 during the COVID-19 pandemic. 1 We surmise 27 that there are notable differences between our practice characteristics accounting for our 28 perspectives, 2 but ultimately agree that telemedicine encounters should have an enduring role 29 in future allergy/immunology (A/I) care. 30 We hypothesize that Zhu et al. experienced less cancellations due to their longer study period. 1

Our analyses covered the initial three weeks of the shutdown in New York State, 2 where 32 patients were contending with employment, school, and childcare challenges, while also 33 grappling with the possibility of a severe COVID surge in Western NY. We suspect many patients 34 delayed their elective A/I appointments given the uncertainty of the times. Over time, our 35 practice experienced a decrease in cancelled appointments as patients adjusted to COVID-19 36 related restrictions in the weeks following our data collection. 37 The difference between Canadian and American healthcare may have also played a role in 38 cancellation rates since nationalized healthcare in Canada leads to longer wait for specialty 39 care, 3 so patients in Zhu et al's analysis may have wished to avert further delay of their 40 appointment. 41 We agree with Zhu et al that there should be a role for telemedicine beyond the pandemic, 42 particularly for certain conditions, as previously discussed in both of our reports, 1,2 and we have 43 shown that our physicians felt the majority of telemedicine encounters to be complete. 2 We 44 have also found favorable patient feedback regarding telemedicine in a separate report of our COVID-19 experiences. 4 However, despite their low cancellation rate, we presume Zhu et al 46 cancelled all food and drug challenges like our practice did. These are essential diagnostic tools 47 in our specialty, and the majority of these cannot be completed remotely. 48 Importantly, telephone encounters outnumbered telemedicine encounters for both groups, 49 and this represents a significant challenge for adequate reimbursement. Despite the rapid 50 adoption of telemedicine, reimbursement in New York State remains sub-optimal compared to 51 in-person visits, and this has impact on practice sustainability. Reimbursement must be 52 addressed before A/I practices can successfully integrate telephone and telemedicine visits into 53 their business models. We believe an A/I practice offering a combination of both in-person and 54 telemedicine appointments depending on patient diagnoses and preferences will be the ideal 55 model to maximize efficiency for both provider and patient. 

Appointment Characteristics during COVID-19 Restrictions -A 67

Canadian Allergy/Immunology Centre Perspective. 2020. JACI In Practice

Appointment Characteristics in an 69

Allergy/Immunology Practice in the Immediate Aftermath of COVID-19 Restrictions

Wait Times in Ontario

Telemedicine Encounters in an Allergy/Immunology Practice During the COVID-19

Ann Allergy Asthma Immunol