TELEMEDICINE IN THE CARE OF COLORECTAL PATIENTS AND THE COVID-19 PANDEMIC

ABSTRACT

Purpose/Background: Evaluate telemedicine usage in the care of colorectal surgical patients a single regional integrated health care delivery system before and after COVID-19 related shelter in place (SIP) orders. Hypothesis/Aim: Telemedicine can bridge gaps in care delivery for colorectal patients during the COVID-19 pandemic. Methods/Interventions: All new consultations to colorectal surgery from January 1, 2019 to June 13, 2020 were queried to assess trends in appointments generated from the consultation, defining the onset of SIP as March 16, 2020. Appointment types were defined as office visits (in person), video visits or telephone visits. Telemedicine includes both video and telephone encounters. Further analysis using patient and surgeon characteristics as well as diagnosis type (benign, urgent, cancer) were used to perform multifactorial analysis to assess any factors associated with implementation trends. Data was analyzed from January 1, 2019 to Aug 19, 2020. Results/Outcome(s) A total of 5,349 of new consultations occurred within the study period, with 4,727 before and 622 after SIP orders, respectively. Prior to SIP orders, in-person office visits were the most prevalent type of encounter (4,485/94.9%), followed by telephone (240/5.1%) and video (2/0%). After SIP orders the absolute number of new consultations per week decreased significantly, and telephone visits were the most prevalent type of encounter (231/37.1%), followed by video visits (214/34.4%) and in-person office visits (177/28.5%). The time from placement of new consultation request to first surgeon encounter was 10 days prior to SIP orders, and 6 days after(p< 0.0001). The use of telemedicine was statistically significantly associated with shorter time to first encounter comparing to in-person office visits (10 days vs 5 days, (p<0.0001). Those patients who underwent surgery having been evaluated only using telemedicine were 106 (6.3%) prior to SIP orders, and 139 (68.8%) afterwards. Evaluating the time period after SIP orders, the average time to an operation for patients whose first surgeon encounter was telemedicine based was 28 days vs 31 days for those whose first encounter was an in-person visit (p=0.3383). When demographical data was evaluated, patients aged 65 years and over (OR=0.81) or low socioeconomic status (OR=0.56), or surgeons who were aged over 60 (OR=0.62) were less likely to use telemedicine. However, over time from SIP order onset, all patients and surgeon groups had a trend of increasing telemedicine use. Limitations: This was a single-center study. Conclusions/Discussion: The COVID pandemic increased uptake of telemedicine. Efficiency of processing new consultations improved after SIP orders, and use of telemedicine was associated with shorter time to first encounter. Differences in trends of telemedicine implementation existed, and we found that there were vulnerable patient and provider populations, which would be an area to focus resources to improve accessibility to telemedicine.