key: cord-0921830-19zzumqf
authors: Mustafa, S. Shahzad; Yang, Luanna; Mortezavi, Mahta; Vadamalai, Karthik; Ramsey, Allison
title: Patient Satisfaction with Telemedicine Encounters in an Allergy/Immunology Practice During the COVID-19 Pandemic
date: 2020-06-22
journal: Ann Allergy Asthma Immunol
DOI: 10.1016/j.anai.2020.06.027
sha: 71295d4f61e5c3da4f39892bb8024e557e38a804
doc_id: 921830
cord_uid: 19zzumqf

nan

The use of telemedicine dates as far back as 50 years ago, when the University of 1 Nebraska used interactive telemedicine to transmit neurologic examinations. 1 Since that time, 2 despite advances in available technologies, and proven utility of telemedicine in 3 allergy/immunology (AI), 2,3 the uptake of telemedicine by AI physicians remains low. 4 With the 4 global spread of novel coronavirus disease 2019 (COVID- 19) , AI physicians were abruptly forced 5 to change their mode of health care delivery. Given the need for social distancing and exposure 6 mitigation, many practices quickly adapted to remote encounters from primarily in-person 7 care. 5 As it has become clear that the COVID-19 pandemic will have long lasting consequences, 8 the emergence of telemedicine presents an opportunity for optimizing healthcare delivery in 9 our specialty. Given the paucity of data on patient satisfaction with telemedicine, we aimed to 10 further characterize this understudied area. 11 We prospectively collected patient encounter data for the four-week period from April 12 13 -May 8, 2020 among four physicians at the Rochester Regional Health (RRH) AI practice. The 13 appointment type (in-person, telephone, telemedicine) was tracked for all encounters, but only 14 telemedicine encounters were studied further. Telemedicine encounters were completed using 15 the following third party vendors: Epic Warp (EHR, Verona, WI), Skype (Palo Alto, CA), FaceTime 16 (Apple, Cupertino, CA), and Doximity (San Francisco, CA) depending on patient preference. For 17 telemedicine encounters, the following were collected: number of new patient (NP) 18 encounters, number of follow up (FU) encounters, patient gender, age, primary diagnosis, 19 biologic therapy or immunotherapy, and encounter completeness as determined by the 20 treating physician. Patients evaluated by telemedicine were contacted by telephone within 21 seven days to answer three patient satisfaction questions (Table 1) The COVID-19 pandemic facilitated widespread adoption of telemedicine in AI practices. 47 Despite the sudden change in the mode of healthcare delivery, our results show that patients 48 have been highly satisfied with these encounters. Nearly 97% "agreed" or "strongly agreed" 49 that they were satisfied with their telemedicine encounter. These rates mirror similar work by 50 Waibel et al and Staicu et al that demonstrated 98% of patients were satisfied with a 51 telemedicine evaluation. 3,6 Additionally, in our study, the majority of patients felt their 52 telemedicine encounter was as satisfactory as an in-person encounter, whereas only 12.8% of 53 patients disagreed with this sentiment. Although telemedicine has been presently necessary for 54 social distancing to mitigate risk of exposure to COVID-19, we hypothesize that going forward, 55 patients may continue to favorably view telemedicine due to its potential to save time and 56 improve access to specialty care. These benefits must be weighed against the advantages of an 57 in-person evaluation, including the sense of a more personable interaction, the ability to 58 perform a physical exam and order routine diagnostic testing. 59 Importantly, our data shows that patients report high satisfaction with telemedicine 60 regardless of their primary diagnoses and type of evaluation (NP versus FU). Although nearly 61 half of the encounters were deemed to be incomplete by the treating physician, these 62 encounters still resulted in high patient satisfaction. Although certain diagnoses in the field, 63 such as chronic urticaria, would seem better suited to a telemedicine evaluation, patients also 64 reported satisfaction with their evaluations for allergic rhinitis, food allergy, and asthma. These 65 findings could potentially be explained by patients accepting physician decision-making without 66 customary testing (i.e. spirometry for patients with asthma, or skin testing for evaluation of 67 food allergy), or expecting such testing at future visits. The high patient satisfaction also 68 supports that the clinical history remains the most important part of a medical evaluation, 69 whether it occurs in-person or via telemedicine. 70 We acknowledge that our cohort may be more accepting of telemedicine during the 71 COVID-19 pandemic, and their responses may have been skewed by a desire to positively 72 review their personal physicians. One third of patients could not be reached for follow up, and 73 they may represent a subgroup who had a less positive experience with telemedicine. We also 74 acknowledge that our data is reflective solely of patient satisfaction and not patient outcomes. 75 However, previous data has shown that patient care outcomes are comparable with 76 telemedicine versus in-person visits, 7,8 and that telemedicine can result in cost-77 savings. 6 Comparing video visits to telephone and in-person visits also would also have 78 strengthened our study. Nevertheless, our data on telemedicine mirrors the high level of 79 patient satisfaction that has been previously reported. We urge A/I physicians to continue to 80 educate themselves on evolving telemedicine regulations and reimbursement unique to their 81 practice settings. 9 The uptake of telemedicine was hastened by the COVID-19 pandemic, but it 82 is likely to be an important part of AI practices in the post pandemic era. 

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Accessed 6/10/2020