ABSTRACT
Rationale: The emergence of the novel SARS-CoV-2 has caused a global pandemic costing the lives of thousands of people. In the US, COVID-19 is now the third leading cause of death among those aged 45 through 84. Lung transplant (LTx) recipients may be at increased risk for fulminant novel SARS-CoV-2 COVID-19 infection due to their immunosuppressed state. Within solid organ transplant (SOT) recipients, the reported mortality rate has ranged from 5% to 40%. Observational studies of LTx recipients have noted a mortality rate of 10% to 34%. To further understand the mortality rate in LTx recipients, we retrospectively evaluated LTx patients at our center with COVID-19. Method: We identified LTx recipients infected with COVID-19 by nasopharyngeal swab at our institution in the Bay Area. Baseline demographics and clinical data were obtained through review of the electronic medical record (EMR) from 3/20/2020 to 12/18/20. Results: Eighteen LTx recipients were diagnosed with COVID-19 infection. The mean age was 55.1 years (SD ± 3.0) and the majority were male (Table 1). Eightynine percent of patients had 2 or more comorbidities, which included hypertension, diabetes, coronary artery disease, and chronic kidney disease. Clinical presentation ranged from mild to severe, 11% of patients were monitored at home and 89% required hospitalization. Of those hospitalized, 50% were treated in the intensive care unit (ICU). The survival rate of COVID-19 in this population was 94%. One patient who recovered from COVID-19 later died in hospice care related to other comorbidities. Conclusion: Lung transplant recipients infected with COVID-19 were mostly male and most had two or more comorbidities. Most patients had severe infection requiring hospitalization and of these, half necessitated ICU level care. The overall survival rate, however, was higher than has been reported in LTx recipients at other centers. Favorable survival outcomes may be due to disease education and prompt access to healthcare in this LTx population. Additionally, during this study period, the Bay Area did not experience the same overwhelming surge of COVID-19 cases that has been seen in other regions of the United States. Further studies are needed to evaluate factors affecting COVID-19 mortality rate in LTx patients. .
ABSTRACT
RATIONALE: The COVID-19 pandemic prompted broad implementation of telemedicine in the United States, accounting for nearly 50-60% of ambulatory encounters. Little is known about the experience of patients with chronic lung disease and their providers with this transition. We examined the impact of widespread telemedicine expansion on patients and providers within an academic ambulatory pulmonary practice. METHODS: This cross-sectional study included patients and providers from the UCSF Ambulatory Pulmonary Practices. Visits were conducted in-person or by telemedicine consultation between August 2019-September 2020. Patient experience was evaluated using the Press Ganey survey, which is administered to all patients after the visit. For this study, likelihood of recommending the provider's office and provider communication domains were assessed. We compared responses before widespread adoption of telemedicine (pre-TM, August 2019-February 2020) and after (post-TM, March 2020-September 2020). Providers who completed at least one telehealth visit during the study period were invited to participate in a survey assessing satisfaction, barriers and facilitators to telehealth, and the scope of pulmonary practice amenable to telemedicine. Patient and provider experiences were analyzed using a two sample t-test of difference in means. RESULTS: Pre-TM, 5% (167/3435) of visits were done by telemedicine, compared to 75% (2721/3635) post-TM. Press Ganey surveys were completed by 391 and 477 patients pre-TM and post-TM, respectively. There were no significant differences pre-TM vs post-TM for provider communication (p=0.78) or likelihood of referral (p=0.55), or between in-person and telemedicine consultation between August 2019- September 2020 for either provider communication (p=0.06) or likelihood of referral (p=0.31). 33 of 36 (92%) providers from general pulmonary, interstitial lung disease, cystic fibrosis, severe asthma, and lung transplant clinics completed the survey. 51% of responders were in practice for ≥10 years and providers spent an average of 13 hours per week ± 2.55 (SD) in clinic. Comparing telemedicine and office visits, providers reported no difference in visit comfort, and 60% reported no difference in quality. Most providers rated telemedicine and office visits equally among the patient evaluation, provider workflows/logistics, and overall experience domains, though telemedicine was preferred for short-term follow-up, providing access, and efficiency, and in-person visits were preferred for the ability to assess exam findings (Figure 1). CONCLUSIONS: After rapid adoption of telemedicine, patients rated visits highly and most would recommend their provider's office. Providers perceived telemedicine visits improved care access and efficiency. These findings are important for ongoing integration of telemedicine into our healthcare delivery models.