ABSTRACT
Background: Our health system serves a vast rural population that creates care gaps for pediatric specialty services. Ask-A-Doc is a formalized “curbside consult” e-Consult service between PCP and specialist. It uses asynchronous messaging to ask a question, and have it answered and documented in the EHR within the requested timeframe. We describe the impact Ask-ADoc has had on delivery of pediatric specialty care. Methods: We analyzed specialty enrollment, volume of consults, number of inperson clinic referrals saved by Ask-A-Doc, average turn-around time, and referring provider satisfaction. In-person referrals saved was determined by how many Ask-A-Doc questions did not incur an in-person evaluation within 60 days of Ask-A-Doc encounter. We also analyzed utilization of Ask-A-Doc prior to and after April 2020, when the COVID pandemic began to impact our clinics. Results: Twelve pediatric specialty services have adopted Ask-A-Doc since March 2018. The number of specialty services using Ask-A-Doc increased from 7 at the end of 2018 to 12 at the end of 2020. Volume of Ask-A-Doc consults increased from 50 in 2018, to 508 in 2019, to 1396 in 2020 (figure 1). Of the total pediatric specialty outpatient referrals, an average of 15% are Ask-A-Doc consults. Services with higher rates of Ask-A-Doc utilization per total referrals placed are Infectious disease (67%), Nephrology (36%), and Hematology/Oncology (35%). Average turn-around time for specialist to answer the Ask-A-Doc question is 9.6 hours. Ask-A-Doc saved a total of 33 in-person referrals in 2018, 354 in 2019, and 1013 in 2020 (figure 1). Approximately 70% of Ask-A-Doc consults did not require subsequent in-person visits which opened new slots in the pediatric specialists' schedules. Referring physicians were very pleased with Ask-ADoc consults rating an average of 4.9 stars out of 5 (n=362). Eight services had been started on Ask-A-Doc prior to April 2019. We used these 8 services to analyze Ask-A-Doc volumes 1 year prior to and 1 year after the start of the pandemic (figure 2). There was a significant increase in average Ask-A-Doc consults per month from pre to post-pandemic years (64.8 to 106.7, p=0.0002). During this same time, average days to be seen for inclinic consultations significantly decreased by 14.5 days, from 57.2 to 42.7 (p=0.003) for these services. Conclusion: Ask-A-Doc e-Consult service provided considerable value to pediatric specialties. Ask-a-Doc 1) provided timely specialty care (average turnaround time of 9.6 hours);2) avoided face to face visits that were unnecessary, opening up over 1,000 new patient slots;and 3) improved access to care, allowing sicker patients to be seen sooner. Referring providers found the service to be extremely helpful. Participation as well as use of Ask-a-Doc continues to grow in pediatrics. Ask-a-Doc has brought us one step closer to “right care, right setting, right time”.
ABSTRACT
BACKGROUND: Delay in acceptance or refusal of vaccination despite vaccine availability comprise a continuum of attitudes known as vaccine hesitancy. To date, three COVID-19 vaccines have been granted emergency use authorization in the U.S.;yet hesitancy to accept vaccination against COVID-19 remains common. Understanding the nature of inter-brand preferences amongst7 these vaccines may help inform vaccine allocation and outreach strategies. METHODS: In April 2021, a de-identified, web-based survey was administered to a convenience sample of respondents across forty-eight states, assessing standard demographics and presence of COVID-19 vaccine brand preference. Those indicating a preference then ranked four COVID-19 vaccine brands presented in random order. Vaccine hesitancy due to brand preference was assessed as the time length for which the respondent was willing to postpone vaccination if their preferred brand of vaccine was unavailable. RESULTS: Of 1,068 respondents, 55.4% endorsed a preference for a particular COVID-19 vaccine brand. On univariate analysis, preference presence differed significantly by age (p=0.011) and religion (p=0.012). The 50-64 age group had the lowest presence of preference (47.9%) while the 18-29 (61.5%, p=0.002) age group had the highest preference presence. The religious group with the least presence of preference was Jewish (45.2%) while the Atheist/ Agnostic (60.0%, p<0.001) and Catholic (59.2%, p=0.012) groups had the highest preference presence. Upon multivariable analysis however, only age was found to be an independent predictor of preference presence (p=0.027). 45.9% (490/1,068) of all respondents would postpone vaccination if their preferred brand was unavailable, with 14.6% (156/1,068) willing to wait three weeks or longer. Willingness to postpone vaccination based on brand availability varied significantly only by religion on both univariate (p=0.022) and multivariable analysis (p=0.043), with the lowest rates of postponement among the Jewish (43.4%) and the highest among Atheists (63.0%, p<0.001) and Catholics (53.1%, p=0.073). Respondents ranked brands in one predominant order (χ2=765.64, p<0.001). Pfizer was preferred over Moderna (Z=-9.405, p<0.001), JnJ (Z=-15.545, p<0.001), and AstraZeneca (Z=-17.399, p<0.001). Moderna was preferred over JnJ (Z=-11.658, p<0.001) and AstraZeneca (Z=-16.782, p<0.001), and JnJ over AstraZeneca (Z=-10.492, p<0.001). Besides the 65+ subgroup which did not have a significant preference between Pfizer or Moderna vaccines (p=0.773), all age and religious groups had the same rank preferences with all paired comparisons similarly significant, p≤0.001. CONCLUSIONS: Age independently predicted the presence of COVID-19 vaccine brand preference while religion independently predicted vaccine hesitancy due to said preference. Further evaluation of the causes and consequences of such inter-brand preferences may inform efforts to increase vaccination among vaccine-curious individuals and facilitate progress towards herd immunity.