Access to Otolaryngologic Telemedicine Care Across the COVID-19 Pandemic at an Urban Tertiary Hospital System.

Objective: To describe associations between patients' demographic characteristics and access to telemedicine services in an urban tertiary academic medical system across the COVID-19 pandemic, and to identify potential barriers to access. Methods: This was a retrospective cohort study conducted at a single-center tertiary academic medical center. The study included adult patients undergoing outpatient otolaryngologic care in person or via telemedicine during 8 week timeframes: before the pandemic, at the onset of the pandemic, and during later parts of the pandemic. Patients were characterized by age, sex, race, insurance type, primary language, portal activation status, income estimate, and visit type. Where appropriate, chi-squared tests, Wilcoxon signed-rank tests, and logistic regression were used to compare demographic factors between the cohorts. Results: A total of 14,240 unique patients [median age, 58 years (range, 18-107 years); 56.5% were female] resulting in a total of 29,457 visits (94.8% in-person and 5.2% telemedicine) were analyzed. Patients seen in person were older than those using telemedicine. Telemedicine visits included a higher proportion of patients with private insurance, and fewer patients with government or no insurance compared to in-person visits. Race, income, and English as primary language were not found to have a significant effect on telemedicine use. Conclusion: In an urban tertiary medical center, we found significant differences in sociodemographic characteristics between patients who accessed otolaryngologic care in person versus via telemedicine through different phases of the COVID pandemic, reflecting possible barriers to care associated with telemedicine. Further studies are needed to develop interventions to improve access.

Essential inpatient otolaryngology: what COVID-19 has revealed.

PURPOSE: To identify areas of critical otolaryngology contributions to inpatient care resistant to disruption by the COVID-19 pandemic. METHODS: Medical records of 614 otolaryngology consults seen between January and June of 2019 and 602 seen between January and June of 2020 were reviewed. Extracted data included patient demographics, SARS-CoV-2 status, medical comorbidities, consult location, consult category, reason for consult, procedures performed, and overall outcome. Prevalence of data items was compared using t tests and Chi-squared tests. RESULTS: The number of monthly consults to the otolaryngology service remained approximately stable after the onset of the COVID-19 pandemic. However, there was a substantial increase in ICU consults and a decrease in ER and floor consults. The proportion of otology, rhinology, and head and neck consults decreased while that of airway consults-most of which were tracheostomy-related-greatly increased. While the top ten reasons for consult remained essentially the same, they dramatically increased as a percentage of consults during COVID-19 (55-92%), whereas there was a dramatic decrease in the proportion of less frequent consults. CONCLUSION: The changes in otolaryngology consultation patterns seen after the onset of the pandemic are multifactorial, but may be attributed to novel pathologies, attitudes, and policies. Nonetheless, these patterns reveal that a set of core otolaryngologic issues, including acute airway issues, head and neck lesions, severe sinusitis and epistaxis, are essential and need to be addressed in the inpatient setting, whereas the significant drop in other consults suggests that they may be appropriately managed on an outpatient basis.