ABSTRACT
Background: The COVID-19 pandemic has disrupted health care systems worldwide. Access to nutrition care is vital, especially considering the unique nutrition needs of patients with gastrointestinal conditions. In this study, we aimed to determine local effects of the COVID-19 pandemic, with respect to nutrition care. Method(s): We performed a retrospective descriptive review of internal operational data at Dayton Children's Hospital. We captured data on the number of new patient office visits for malnutrition-related diagnoses and the number of stand-alone nutrition visits completed in-person and via telehealth. We hypothesized need for malnutrition-related visits would increase and telehealth visits would be underutilized, leading to gaps in care during the COVID-19 pandemic. Result(s): Numbers of total stand-alone nutrition visits declined in 2020 from 41 in January to less than 10 in April. Numbers of telephone visits did not rise above 10 for any month in 2020. Volumes of new patient visits for malnutrition-related conditions in 2020 declined to as low as 56 visits per month in April, rising to over 100 by June. Conclusion(s): While volumes of new patient office visits with malnutrition-related diagnoses rose, volumes of stand-alone nutrition visits declined. We found gaps in care as stand-alone nutrition telehealth visits were underutilized during this time period. Opportunities exist to expand the use of telehealth technology to nutrition professionals and prevent future gaps in care. .
ABSTRACT
In 2020, telehealth (TH) in pediatric gastroenterology (GI) practice experienced unprecedented, meteoric growth, despite undefined best practices for the subspecialty. Use of synchronous video for TH first occurred in 1964, it was increasingly described in the literature from the 1970s to 1990s, and then catapulted to the forefront during the COVID-19 Public Health Emergency (PHE) beginning March 2020. Due to the sudden need for increased TH utilization by nearly all health care providers TH became essential to clinical practice. TH broadly encompasses most remote activities of clinical care, provider and patient education, and general health services. Prior to the COVID-19 PHE, surveys indicate that only 50% of North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) membership had any experience with telehealth. Although experience has grown dramatically, best practices for TH in pediatric GI, hepatology, and nutrition remain undefined and non-standardized. Key areas for review include: historical perspective, general and subspeciality usage, health care disparities, quality of the provider-patient interaction, modes of health care delivery, logistics and operations, licensure and liability, reimbursement and insurance coverage, research and quality improvement priorities, and future use of telehealth in pediatric GI with a call for advocacy. This present position paper from the Telehealth Special Interest Group of NASPGHAN provides recommendations for pediatric GI-focused telehealth best practices, reviews areas for research and quality improvement growth, and presents advocacy opportunities. Summary of Recommendations * The decision of when and how to use telehealth should be shared between patients-families and providers with the goals to achieve quality medical care and excellent patient experience * Telehealth is convenient for patients-families, affords a high degree of satisfaction and may improve access to high-value subspecialty care * Digital disparities exist for telehealth and providers need to be mindful of inequity in telehealth access and healthcare delivery * Individual providers carry the responsibility of licensed, secure, and HIPAA-compliant telehealth delivery in accordance with governmental regulations * Advocacy for permanent insurance coverage, reimbursement parity and universal licensure is urgently needed.