ABSTRACT
Background: The COVID-19 pandemic has allowed for the rapid expansion of telemedicine to continue to provide patients access to medical care while minimizing in-person contact. Studies have suggested that telemedicine may worsen healthcare disparities in certain segments of the population, driven in part by lack of access to appropriate technology or poor technological literacy. The aim of this study was to determine the impact of telemedicine on clinic no-show rates in the ambulatory gastroenterology setting. Methods: Single-center retrospective study of no-show visits for ambulatory in person (IP) and Telemedicine clinic appointments comparing the 15 months pre-pandemic to the first 15 months of the pandemic using an administrative database. The pre-pandemic cohort (PPC) was from January 1, 2019 to March 15, 2020 and the pandemic cohort (PC) was from March 16, 2020 to June 1, 2021. Race/ethnicity and preferred language were self-reported by patients during registration. Insurance types were categorized into private or public insurance. Statistical analysis was performed using descriptive statistics and univariate analysis. Results: There were 1841 no-show visits during the study period, 963 (52.3%) of which were PPC and 888 (48.2%) PC. In the PPC, 62.5% of these no-show visits were IP, whereas 86.8% were VV during the pandemic. The overall no-show rate decreased during the pandemic from 9.8% to 6.9% (p <0.0001). The no-show rate decreased in the PPC amongst Black (11.9 vs 8.6;p = 0.002) and Non-Hispanic White (53.8 vs 48.3, p=0.018) patients, but increased in Asian patients (8.2% vs 11.9%, p=0.007). There was a decrease in the proportion of no-show new patient appointments during the pandemic (28.2 vs 18.4, p <0.0001) along with telephone visits (22.5 vs 10.5, p<0.0001). Age >60 (OR 0.8, 95% CI 0.69-0.91, p=0.002), Hispanic ethnicity (OR 0.55, CI 0.46-0.66, p<0.00001), non-English speaking (OR 0.62, CI 0.47-0.83, p= 0.001), and follow-up appointments (OR 0.34, CI 0.28-0.4, p<0.00001) were associated with lower odds of showing up for an appointment during the pandemic period. Conclusion: When utilizing telemedicine as the primary modality for ambulatory clinic visits, there was an overall decrease in the proportion of no-show appointments during the pandemic. No show rates were improved for Black and non-Hispanic white patients but worsened for Asian patients. Elderly, Hispanic ethnicity and non-English speaking patients were also at higher risk of no-show visits during the pandemic. Future studies should aim to identify the risk factors within these populations that can be modified to improve access to healthcare. (Table Presented)
ABSTRACT
Background: The emergence of the SARS-CoV-2 virus in December 2019, and the resultant expansion of telemedicine coverage by insurers has led to a rapid increase in telephone and video visits (VV) to meet the clinical demand while minimizing in-person contacts. The aim of this study was to identify the impact of telemedicine on access to healthcare of various subpopulations in the gastroenterology ambulatory setting. Methods: We performed a singlecenter retrospective study of ambulatory in person (IP) and Telemedicine clinic appointments comparing the 15 months pre-pandemic to the first 15 months of the pandemic using an administrative database. The pre-pandemic cohort (PPC) was from January 1, 2019 to March 15, 2020 and the pandemic cohort (PC) was from March 16, 2020 to June 1, 2021. Demographic data were collected from the electronic medical record, including self-reported race/ethnicity and preferred language during registration. Insurance types were categorized into private or public insurance (Medicare or Medicaid). Statistical analysis was performed using descriptive statistics and univariate analysis. Results: A total of 20,708 ambulatory visits were completed during the study period, 8,793 (42.4%) of which were PPC and 11,915 (57.6%) during the pandemic. In the PPC, 90.7% of visits were in person, whereas 95.2% were video visits during the pandemic. The average patient age decreased during the pandemic (50.4 vs 48.8, p <0.0001). During the pandemic, there was a significant increase in the proportion of patients seen who were female (p=0.002), age < 40 (p=0.0002), of Latinx ethnicity (p=0.12), and English speaking (p=0.0006), but there was a significant decrease in patients age > 60 (32.7% vs 29.1%, p<0.0001). There were fewer non-English speakers during the pandemic mainly driven by a decrease in Chinese speakers (p=0.002). Black patients (p<0.0001) and Spanish speakers (p=0.001) in the PC were disproportionately receiving telephone visits. In the PC, patients who held private insurance had significantly more video visits (p=0.0003), whereas patients with public insurance had significantly more in-person visits (p<0.0001) and telephone visits (p<0.0001). Conclusion: The use of telemedicine markedly increased during the pandemic for ambulatory gastroenterology clinic visits. Telemedicine during the pandemic led to significantly increased clinical encounters for English speakers, younger patients, and Latinx patients, compared to the pre-pandemic cohort. In contrast, older patients and non-English speakers experienced a decrease in clinic visits with the widespread adoption of telemedicine. Although language barriers and technological literacy are plausible explanations for these changes, further studies are needed.(Table Presented) Table 1: Patient Demographics for Completed GI Clinic Visits (Table Presented)Table 2: Demographics Differences by Visit Type Comparing Pre-pandemic to Pandemic Cohort
ABSTRACT
Background: Rapid On-Site-Evaluation (ROSE) with an in-room pathologist (ROSE-P) has been shown to improve the diagnostic yield of specimens obtained from patients undergoing Endoscopic Ultrasound Fine Needle Aspiration Biopsy (EUS-FNAB) of pancreatic lesions. Recently, there has been an increased interest and utilization of telecytology (ROSE-T) to address social distancing during the COVID-19 pandemic and to optimize clinical workflows. With ROSE-T, a technician equipped with a video conferencing capable microscope unit prepares the EUS-FNAB cytology slides, which are then examined by Cytopathologists remotely. The purpose of this study is to compare diagnostic outcomes of ROSE-P prepandemic with ROSE-T during the COVID-19 pandemic. Methods: A single-center mixed retrospective-prospective cohort study of patients who underwent EUS-FNAB of solid pancreatic lesions with ROSE was conducted. All patients who underwent EUS-FNA were entered into a prospective database. The retrospective arm was patients who underwent ROSE-P pre-pandemic, whereas the prospective arm was patients who underwent ROSE-T during the pandemic. 165 patients in each group were needed to detect a 10% difference in diagnostic yield between the two groups, based on sample size calculation. An interim analysis was performed based on available data. Statistical analyses were performed using descriptive statistics and univariate analysis. Results: A total of 295 patients were enrolled in the study. 168 (57%) were in the ROSE-P group and 127 (43%) in the ROSE-T group. ROSE-T was associated with significantly more needle passes than ROSE-P (3.7 vs 3.0, p<0.0001). There was increased use of 22-gauge needle and decreased use of 25-gauge needles with ROSE-T during the pandemic (p = 0.012). There was no difference in age (63.4 vs 66.3, p=0.14), gender (43.5% vs 48.8 female gender, p=0.36), means mass size (27.2 vs 27.5 mm, p=0.14), mean procedure time (48.2 vs 46.2 minutes, p=0.92), adverse events (0.6% vs 0%, p=0.38), or diagnostic yield (97% vs 98.4%, p=0.38) between ROSEP and ROSE-T respectively. Conclusion: Rapid on-site evaluation using Telecytology was associated with more needle passes and more frequent use of 22-gauge needles as compared to ROSE-P;however, there was no difference in other important outcomes such as diagnostic yield, procedure time, and adverse events. (Table Presented)