The clinical and cost effectiveness of telemedicine consultation in tertiary paediatric allergy during the COVID-19 pandemic: A comparative study

ABSTRACT

Background: The COVID-19 pandemic has enhanced the growth of telemedicine in an unexpected speed. Our study compares the service and cost effectiveness of telephone clinics (TC) to standard face to face clinics (FTFC) in the paediatric allergy service. Method: This retrospective study looked into paediatric allergy clinic activities from April 1-October 1, 2020 in the Great North Children Hospital, Newcastle. We also collected data from standard FTFCs in the pre-COVID period as comparative group. Clinic activities were reviewed by looking into patients' clinic notes and letters. Results: Clinic attendance rate in both groups was similar (91%, 94%). 9% of the patients were not available at the time of TC appointment. Majority did not answer but 4 consultations were discontinued due to language barrier. Up to 73% of patients did not have allergy tests after TC, despite being clinically indicated in half of them. Serum IgEs (sIgE) has become the preferable diagnostic option in TC. The median of sIgEs ordered per patient is 7 in TCs, as compared to 6 in control (p < 0.05). This has resulted in a 20% increase in laboratory cost. Clinic discharge rate is higher in FTFC (41%) as compared to TC (25%). The average follow-up time interval after TC is shorter than FTFC, 7.6 months and 9.4 months respectively (p < 0.05). More regular follow-ups in TC group has led to an increase of average clinician follow-up cost per patient by 32%. Conclusion: A telemedicine-based allergy service model can be more time-effective and improve patient access to specialist care, only with well-designed framework and planning. Screening criteria for selecting suitable TC patients can be the key to success. We present an example of recommended screening criteria based on patients' diagnosis and certain special circumstances. (Figure Presented).