ABSTRACT
Background: The COVID pandemic has markedly increased the adoption of telehealth. Patient satisfaction with telehealth may vary with the age and locale of the patient including the distance from the medical center and the setting the patient resides in (rural vs. urban). University of Utah Health is uniquely positioned to assess patient satisfaction in this transition due its very large geographic referral area from the continuum of the rural-urban settings. Aims: Compare pre-pandemic in-person visits to post-pandemic telehealth and in-person visits. Explore the temporal and spatial effect of a post-pandemic telehealth visits. Methods: Exceptional patient experience (EPE) surveys were sent to all patients after ambulatory care visits and consists of 8 questions. Possible responses ranged from Very Poor to Very Good on 5point scale. Survey responses were stratified by type of visit (in-person or telehealth), distance from medical center, rural vs. urban, age and time before and after start of COVID pandemic. Summary statistics of the response variables by pre pandemic in-person visit and post pandemic telehealth were done. We fitted a linear regression model adjusting for age and gender using the Covariate Balancing Propensity Score Estimation. Scores for entire institutional cohort and department of Gastroenterology were compared. Percentages reported are patients responding “Very Good.” Results: EPE scores were compared from in person pre-pandemic (11/01/18-2/28/20) to telehealth post-pandemic (04/1/20-12/31/20) with a transitional month of March (3/20) excluded. This included 235,227 returned surveys (14.0% response rate) of which 140,438 (GI 1852) were in person pre-pandemic and 87,135 (GI 1114) were telehealth post-pandemic. The entire cohort including GI patients reported greater satisfaction with in-person compared to telehealth visits with greatest % differences in “Overall assessment” and “Likelihood to recommend”. The other 6 questions showed similar scores between in-person and telehealth visits, but also favored in-person (Table 1, p<0.01 for all comparisons). Younger (£40) GI patients had higher scores for telehealth compared in person visits (p<0.03). The temporal effect of post-pandemic GI telehealth visits over time showed significantly higher scores of “ease of scheduling an appointment” “Likelihood to recommend” and “staff work together” in December compared to April (p<0.001) The spatial effect of a post-pandemic GI telehealth visits showed significantly lower scores for all questions for rural areas over micro/metropolitan for telehealth (p<0.001). Conclusion: All patients including GI patients preferred in person to telehealth visits though satisfaction was high with both. Younger GI patients preferred telehealth visits. Satisfaction with telehealth increased over time from the start of the pandemic.(Table Presented)
ABSTRACT
Background: The COVID-19 pandemic disrupted the way care is delivered to patients with chronic conditions such as heart failure (HF). Many outpatient encounters are now conducted virtually via telehealth. Whether virtual visit for HF results in similar type of interventions as when the patient is seen in person is not known. Methods: Starting on March 15, 2020, all non-time sensitive outpatient in-person appointments at our institution were cancelled and transitioned to virtual appointments where possible. We included all patients seen in a tertiary care HF clinic from February 18 to March 13 (pre-Covid) and from March 16 to May 15 (post-COVID). We examined the volume of in-person and virtual visits and compared medication titration rates pre- and post-COVID. Results: The study cohort included 745 patients, mean age 60.7+/-15.3 years, 65.2% male, 80.9% Caucasian, 7.7% Hispanic/Latino. Of these, 227 patients were seen pre-COVID and 518 post-COVID. All appointments were in-person pre-COVID. After the change, only 18% of appointments were in-person while 82% were virtual. Outpatient volume decreased after March 15, but gradually increased, eventually to volumes that exceeded pre-COVID (Figure). Detailed results on medication titration are shown in Table. Diuretic titration took place in 33/227 (14.5%) of patients pre-COVID and 83/518 (16.0%) post-COVID (p=NS). Among 567 patients with HF with reduced ejection fraction (HFrEF), titration of guideline-directed medical therapy (GDMT) took place in 86/172 (50.0%) of patients pre-COVID and 159/395 (40.2%) post-COVID (p=0.03). Among the 395 HFrEF patients seen post-COVID, GDMT was titrated in 33/68 (48.5%) patients seen in person and 126/327 (38.5%) seen virtually - p=0.13. Barriers to medication titration in virtual visits were lack of blood pressure readings and lack of recent laboratory results. Conclusion: Telehealth has become an essential method of outpatient care delivery for chronic HF. Once implemented, it offered efficiencies including improved access to the HF clinic thanks to higher throughput capacity compared to physical clinic space. However, we identified that GDMT titration took place less frequently than during in-person visits. Since it is anticipated that telehealth use will continue into the future, approaches to maximize GDMT in the absence of traditional direct physical contact with HF patients are needed.