Caregiver and allergist views on virtual management of food allergy: A mixed methods study

ABSTRACT

Background: The COVID-19 pandemic resulted in an abrupt and unanticipated shift to health care delivery, including a transition from in-person to virtual physician encounters. To date, few studies have examined patient and physician views on virtual food allergy management. To this end, we sought to examine caregivers' and allergists' views on virtual allergy care of food allergy. Method: In an embedded mixed-methods study of Canadian caregivers of children (<18 years) and allergists, we collected quantitative and qualitative data on levels of satisfaction and comfort with virtual care (both on a scale of 0-100) and perceived advantages and disadvantages, respectively. Data were collected from October-December 2020. Quantitative data were analyzed descriptively. Qualitative data were analyzed thematically. Findings were integrated in the interpretation. Results: In total, 66 caregivers and 11 allergists participated. Quantitatively, caregiver satisfaction was high and comparable, regardless of type of care, or type of delivery (virtual vs other). In comparison, allergists' satisfaction was lowest for virtual oral food challenge (OFC) and oral immunotherapy (OIT) (mean 40.8 ± 39.7, and 30.2 ± 34.5, respectively;both p < 0.05 vs. initial assessments). Qualitatively, both caregivers and allergists described virtual care as having benefit without the burdens. Qualitative disadvantages of virtual care were, for caregivers, isolation;and, for allergists, limited opportunities for testing and unclear projected utilization of virtual care post-COVID. Conclusion: Caregiver satisfaction was consistently high, although isolation exacerbated by virtual care and more generally, the food allergy itself, remained a concern. Allergist satisfaction was more variable, with preference towards types of care involving less patient risk.