ABSTRACT
Rationale: Telemedicine is a simple way to virtually see a doctor and determine what care a patient may need. The telemedicine platform was introduced to Greater Austin Allergy, Asthma & Immunology (GAAAI) in March 2020 to offer medical services to patients at home, especially for those with concerns due to the COVID-19 pandemic. Common allergy/asthma symptoms include runny nose, nasal congestion, and cough, which tend to overlap with COVID-19 symptoms. We hypothesized an increase in use of ICD-10 codes representing respiratory illness for telemedicine compared with in-clinic visits in an Allergy/Immunology subspecialty network during the COVID-19 epic. This study explores the use of telemedicine during the COVID-19 pandemic from 03/01/2020 through 12/31/2021 in patients seen in an Allergy/Immunology subspecialty network. Methods: GAAAI collected 35,299 patient encounters across 6 clinics from January 1, 2019 through December 31, 2021 and separated patients into the following groups: (1) All visits from 01/01/2019 through 02/28/2020, (2) In-clinic visits from 03/01/2020 through 12/31/2021, and (3) Telemedicine visits from 03/01/2020 through 12/31/2021. The data was imported into RStudio and ICD-10 code frequencies were generated for each group. Results: There was a 49% decrease in ICD-10 code use for respiratory illness for telehealth versus a 38% decrease for in-clinic visits compared with all patients seen prior to March 1, 2020. Acute infections had an 18% increase in telehealth visits and a 53% decrease for in-clinic visits. Immune deficiencies had a 220% increase for telehealth versus a 4% increase for in-clinic visits. Environmental allergy symptoms showed a 38% increase for telehealth and a 19% increase for in-clinic visits. Lastly, food allergies exhibited a 67% increase for both telehealth and in-clinic visits. Conclusions: Our original exploration was centered around patients experiencing respiratory symptoms and utilizing telemedicine to prevent spreading COVID- 19. The results display the opposite, and convey that patients were less likely to utilize a telemedicine visit when experiencing respiratory symptoms. Patients may be prioritizing their primary care physician when concerned about a potential COVID-19 diagnosis over their Allergy/Asthma specialist. It is apparent that there is still an influx of patients for nasal and food allergies for telemedicine and in-clinic visits after 02/2020. Finally, immunocompromised patients preferred to use the telemedicine platform over an in-office visit which may underline their fear of contracting COVID-19.
ABSTRACT
Introduction: The COVID-19 pandemic prompted a rapid shift to telehealth for care delivery. We aimed to assess satisfaction with and preferences for telehealth to improve care experiences for patients with irritable bowel syndrome (IBS). Methods: We conducted a prospective survey-based cross-sectional study from September 29 to November 9, 2020 in a diverse, community-based integrated healthcare system in Southern California. We included members age 18-90 with an International Classification of Diseases 9, 10 code for IBS from an office-based encounter between June 1, 2018 to June 1, 2020. A specifically developed survey (TIBS-CoV2) was emailed to patients. We collected demographic and clinical data from the electronic medical record. We assessed satisfaction via 5-point Likert scale (“strongly agree and agree” was defined as satisfied;“strongly disagree and disagree” as dissatisfied). Using Chi-square and Wilcoxon Rank Sum tests, we compared demographic and clinical characteristics of those who were satisfied and dissatisfied with telehealth in patients with ROME IV IBS. We used multivariate logistic regression to identify predictors for telehealth satisfaction. Results: Of 44,789 surveys sent, 2598 (5.8%) patients responded, 1473 (56.7%) completed the entire survey (median age 60.0 [42.4-71.2], 80.1% female;66.3% non-Hispanic white, 22.1% Hispanic, 5.0% black, 4.0% Asian) and 744 (28.6%) had ROME IV confirmed IBS. 651 (87.5%) patients with IBS used telehealth for their care: 436 (67.0%) were satisfied, 62 (9.5%) were dissatisfied and 153 (23.5%) felt neutral about their experience. No significant differences were seen in sex, race/ethnicity, BMI, marital status, income, IBS subtype or severity between satisfied and dissatisfied groups (Table 1). Telehealth satisfaction was associated with full-time employment (188, 43.1%, p>0.001), a college degree or higher (244, 56.0%, p=0.01), or daily social media use (338, 77.5%, p=0.01). Dissatisfaction was associated with older age (59.2±17, p<0.01), retirement (26, 41.9%, p=0.02) and low self-perceived health literacy (4, 6.5%, p=0.008). Satisfied patients would consider telehealth over a face-to-face visit for a travel time of 30-59 minutes (170, 39.0%, p=0.01);dissatisfied patients did not consider travel time a factor (23, 37.1%, p>0.001). Multivariate analysis confirmed age, a college degree, daily use of social media and travel time of 30-59 minutes as independent predictors of telehealth satisfaction (Table 2). Conclusions: A majority of patients with IBS are satisfied with telehealth and are more likely to use telehealth since the COVID-19 pandemic. Factors including age, available time, education level, health literacy and comfort with technology likely influence satisfaction with telehealth in IBS and may help to identify patients who would be most responsive to a focused IBS-telehealth program.(Table presented) (Table presented)