Harnessing Telemedicine to Improve Access to Care During the COVID-19 Pandemic

ABSTRACT

Objective: Before COVID-19, telemedicine had gained traction as a clinical tool, which was reflected by the adoption of new billing codes. Here we report outcomes in our Endocrine practice, which rapidly switched to exclusively tele-health in March 2020 with no pre-existing systems or protocols for this transition. We hypothesized that barriers to care, including patients’ health literacy, access to technology/internet, and access to remote monitoring tools such as blood pressure cuffs and weight scales, would make the transition to tele-health less successful in a low-income urban setting than in the suburbs. Methods: We measured show rates at Temple Endocrinology outpatient clinic sites using the CPT coding system to compare all scheduled appointments with all completed visits. We selected periods from April 1st to July 31st of 2019 and the same dates in 2020, because outpatient visits were exclusively in-person (2019) or exclusively tele-health (2020). Appointments included both faculty and fellow clinics. Data were stratified by service location amongst four major clinic sites that serve patients of different socioeconomic and ethnic backgrounds – namely, Temple University Hospital (TUH) in North Philadelphia, an urban federally designated medically underserved area, Temple Fort Washington (FW) serving a high-income suburban area, Temple Center City (CC) serving a high-income urban area, and Temple Jeanes, serving a middle-income suburban area. Results: Surprisingly, the proportion of completed outpatient visits at TUH increased from 68.2% (n = 2,965/4,346) in 2019 to 72.9% (n = 2,997/4,109) in 2020 (p = 0.00001), with an absolute increase of 1.01% in our completed encounters. In contrast, at FW, the proportion of completed outpatient visits decreased from 89.8% (n = 378/421) in 2019 to 79.3% (n =211/266) in 2020 (p = 0.00014). At CC, 90.2% (n = 342/379) visits were completed in 2019 and 89.5% (n = 366/409) in 2020 (p = 0.73). At Jeanes, rates were 75.8% (n = 485/640) in 2019 and 76.7% (n = 615/802) in 2020 (p = 0.69). Discussion/Conclusion: Despite the speed with which we transitioned to an entirely tele-health-based practice at the start of the pandemic, we found that we were equally – if not more able – to complete clinical Endocrinology visits with our population of underserved patients in North Philadelphia. In contrast, at our suburban FW campus, the show rates fell. We are currently examining disease acuity, transportation issues related to in-person visits, and internet access through smartphones in the populations served by TUH and FW. Overall, our data suggest that tele-health can be a successful option for Endocrine practice in an underserved urban area.