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Implementation study: Challenges of rapid telemedicineimplementation into a small community pediatric allergy-asthma practice
Pediatrics ; 147(3):969-970, 2021.
Article in English | EMBASE | ID: covidwho-1177803
ABSTRACT
Telemedicine is utilized in the United States, but its acceptance has been limited. In the environment of apandemic, the healthcare industry is forced to alter the delivery of care to contain the virus' spread. Utilizingtelemedicine in small community settings may ensure continuity of care and deliver healthcare advice whilereducing the risk of exposure. Program Goals review the challenges, benets, and limitations of rapidlyimplementing telemedicine into one small Pediatric Allergy practice in response to the COVID-19 pandemic.Implementation resources included education via online webinars and online research. Evaluation Care wasdelivered by a physician and nurse practitioner via real-time audiovisual teleconference. Platforms utilizedincluded Zoom and Doxy.me. Preparation included evaluating telemedicine platforms, staff training, andpatient education in the setting of quickly changing regulatory and nancial policies. During the rst month oftelemedicine implementation, clinicians perceived several frustrations. These included reviewing test results without parents possessing the test result copies. Concerns of HIPAA privacy limited document sharing withfamilies. Parents were also visualized writing their child's results which may have impaired their ability toabsorb information provided by the clinician. It was also perceived that direct interaction with the pediatricpatient was decreased due to a lack of engagement with the child. Many younger children were distracted bytheir home setting and did not stay focused on the conversation. Adolescents did actively engage. Despitethese limitations, within 2 weeks, the office successfully provided care for disorders including food allergy,allergic rhinitis, asthma, urticaria and atopic dermatitis. Partial physical exams were conducted, includingassessments of patient appearance, quality of conversation, face/eyelid/skin, chest excursion & chest wallsymmetry, respiratory effort, mental status, and mood/affect. Counseling, education and gross patientassessments were effectively accomplished with parents expressing satisfaction with remote care. Limitations were noted in the setting of an acute asthma exacerbation. These included restrictions in patient assessment,such as vital signs and auscultation of breath sounds. Despite counseling and medication prescriptionprovided via telemedicine, the patient later sought emergency care via ED.

Discussion:

rapid deployment wasachieved in a community small-office setting. Successes included effective patient counseling and educationand delivery of patient care for non-emergent conditions. These could be accomplished with the partialphysical exam available through audiovisual interface. Limitations included decreased engagement of youngerchildren and the lack of document sharing, which can be addressed via other HIPAA-compliant technologyplatforms. Asthma exacerbation was not effectively managed and illustrates the limitations of remotehealthcare in acute situations. However, many patient encounters can be effectively managed with theassistance of telemedicine and may allow for maintaining healthcare delivery in the setting of an acutepandemic.

Full text: Available Collection: Databases of international organizations Database: EMBASE Language: English Journal: Pediatrics Year: 2021 Document Type: Article

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Full text: Available Collection: Databases of international organizations Database: EMBASE Language: English Journal: Pediatrics Year: 2021 Document Type: Article