Tele-Health Implementation During Covid19 Pandemic in Liver Transplant Population: A Focus on Medication Adherence, Patient Satisfaction, Clinical Outcomes and Possible Cost Impact

ABSTRACT

Purpose: The COVID-19 pandemic affected many aspects of health care, including the provision of care in ambulatory care clinics, necessitating the utilization of telehealth. For example, we implemented phone clinics in our hospital to ease access to health care for liver transplant patients. This study aims to assess the impact of phone clinics on patients' perception, adherence to medication, and potential cost reduction. Method(s) This prospective observational study utilized validated questionnaires the telehealth usability questionnaire (TUQ) and Morisky Medication Adherence Scale (MMAS-8), to assess patients' perception of telehealth and medication adherence, respectively. We included all liver transplant patients who received their care through phone clinics from June 1st, 2020, to December 31st, 2020. In addition, clinical outcomes were assessed, such as emergency room visits, development of biopsy-proven rejection, need for hospital admissions, and derangement of enzymes as secondary endpoints. Result(s) We had 422 patients served through phone clinics;416 met the inclusion criteria. The majority of patients were males (61.5%), lived outside Riyadh (63%), used 5-10 medications per day (71%), and were above the age of 60 years (43.7%). The average overall adherence scale was 7.2 (+/-0.91 SD), where 94.5% scored to have medium adherence (score of 6-8), followed by 5.5% with low adherence, while no one had high adherence score. Patients perception scores averages toward the utilization of phone clinic were 1.5 (+/-0.76 SD) for the usefulness of telehealth, 1.4 (+/-0.7 SD) for the ease of use and learnability, 1.54 (+/-0.8 SD) for the interface quality, 1.45 (+/-0.8 SD) for the interaction quality, 2.07 (+/-1.17 SD) for the reliability, and 1.59 (+/-0.88 SD) for satisfaction and future use. The estimated average direct outof- pocket cost savings per patient was 703 SAR (187 USD) per person, with a total reduction of 292,630 SAR (78,033 USD) in all served patients. For clinical outcomes, 31 patients (7.45%) had emergency room visits three months after the phone clinic. Likewise, five patients (1.20%) developed a biopsy-proven rejection, 14 patients (3.36%) were admitted to hospitals, and 50 patients (12.01%) had derangements of enzymes requiring intervention during the specified period. Conclusion(s) Our results show that the utilization of phone clinics in the liver transplant settings was associated with a high satisfaction rate among the served patients with a medium score of medication adherence and potential cost reduction impact.