Comfort in Telemedicine Based on Diagnosis and Reason for Referral in Pediatric Gastroenterology

ABSTRACT

Background: Telemedicine can provide increased patient access to care, cost savings and high patient satisfaction. Payors have extended reimbursement for telemedicine and although few pediatric gastroenterologists had experience with telemedicine before the COVID-19 pandemic, many practices continue to offer this as a care modality model. Comfort in practicing telemedicine for specific conditions amongst NASPGHAN members is not known. This study evaluates comfort in practicing telemedicine for common indications for outpatient GI consultation referral and follow up visit diagnoses. Method(s) In June-August 2020, we surveyed members of NASPGHAN with an instrument that included two multi-select questions 1) Which of the following reasons for referral would you feel comfortable completing with telemedicine? 2) Which of the following conditions would you feel comfortable using telemedicine for a routine follow up? Results: 136 participants answered the two survey items. Constipation (n=121, 89%), heartburn (n=109, 80%), and infant reflux (n=109, 80%) were the reasons for referral most frequently selected. Referral of jaundice (n=26, 19%), second opinion (n=45, 33%), and poor weight gain (n=51, 38%) received the least mentions. For follow up appointments, diagnoses of celiac disease (n=126, 93%), functional gastrointestinal disorders (n=126, 93%), eosinophilic esophagitis (n=120, 88%) were the three most frequent, while liver transplantation (n=24, 18%), intestinal failure (n=26, 19%), and short bowel syndrome without intestinal failure (n=34, 25%) were the diagnoses selected the least. 14 respondents selected comfort with all new patient reasons for referral and follow up visits. Conclusion(s) There is variability in provider comfort to utilize telemedicine for providing consultation or follow up care based on reason for referral or patient diagnosis. Provider comfort in providing care should be considered when offering telemedicine as a practice model moving forward. Reasons underlying provider dis/comfort should be explored using qualitative methods. (Figure Presented).