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Telemedicine improves access without compromising quality of care in patients with cirrhosis
Hepatology ; 74(SUPPL 1):409A-410A, 2021.
Article in English | EMBASE | ID: covidwho-1508759
ABSTRACT

Background:

The COVID-19 pandemic forced an abrupt and urgent adaptation to the use of telemedicine (TM). Though the use of TM in the care of liver disease predates the pandemic, its widespread use has been hindered by regulatory and reimbursement restraints. Furthermore, there is a dearth of data directly comparing clinical outcomes between TM and face-to-face (F2F) visits in patients with cirrhosis. Accurately characterizing outcomes between these modalities may aid in determining under which circumstances TM may be most appropriately incorporated into the care of patients with cirrhosis.

Methods:

Utilizing ICD-10 codes, a retrospectively identified, prospectively followed cohort of patients with cirrhosis was compiled (n=407). Individual encounters were independently vetted through direct review of patient records by study personnel. Two cohorts were identified. The TM cohort (n=151) included encounters conducted via TM (audio or video) from 4/7/2020 - 6/7/2020. The F2F cohort (n=333) included in-person clinic visits from 1/1/2019 - 6/1/2019;representing the standard of care prior to implementation of TM. Each cohort was followed for a total of 6 months from their index visit to assess clinical outcomes including Emergency Room (ER) visits and hospital admissions. Guideline-based hepatocellular carcinoma (HCC) screening was used as a surrogate for preserving standard of care. This included appropriate ordering (by provider) and adherence to recommendation (by patient).

Results:

The two cohorts were similar in composition, without statistically significant differences between race, mean income, insurance carrier, etiology of cirrhosis, or presence of decompensation. There was a significantly higher volume of return visits in the TM cohort vs. F2F cohort (84.1% vs. 59.2%;p<0.001). There were no statistically significant differences between the cohorts in ER visits, hospital admissions, or provider ordering/patient adherence to HCC screening guidelines (Table 1).

Conclusion:

Telemedicine preserved access to care for patients requiring Hepatology services during the pandemic. Telemedicine did not negatively impact quality of care as determined by similar adherence to HCC surveillance compared to in-person visits. Telemedicine is a suitable alternative to in-person visits in patients who otherwise may have difficulty accessing Hepatology care.

Full text: Available Collection: Databases of international organizations Database: EMBASE Type of study: Cohort study / Etiology study / Observational study / Prognostic study Language: English Journal: Hepatology Year: 2021 Document Type: Article

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Full text: Available Collection: Databases of international organizations Database: EMBASE Type of study: Cohort study / Etiology study / Observational study / Prognostic study Language: English Journal: Hepatology Year: 2021 Document Type: Article