Impact of Rapid Transition to Telemedicine-Based Delivery on Allergy/Immunology Care During COVID-19 - PubMed (original) (raw)

Impact of Rapid Transition to Telemedicine-Based Delivery on Allergy/Immunology Care During COVID-19

Lulu R Tsao et al. J Allergy Clin Immunol Pract. 2021 Jul.

Abstract

Background: Coronavirus disease 2019 (COVID-19) necessitated wide-scale adoption of telemedicine (TM) and restriction of in-person care. The impacts on allergy/immunology (A/I) care delivery are still being studied.

Objective: To describe the outcomes of rapid transition to TM-based care (video visit followed by in-person visits dedicated to diagnostic and therapeutic procedures when needed) at an academic A/I practice during COVID-19.

Methods: Demographic data were compared for patients originally scheduled for in-person visits between March 10, 2020, and April 30, 2020, who completed a video visit instead between March 10, 2020, and June 30, 2020, and those who did not. Appointment completion, diagnoses, and drug allergy and skin testing completion were compared for visits between March 10, 2020, and June 30, 2020, and 1 year prior (March 10, 2019-June 30, 2019).

Results: Sixty-nine percent (265 of 382) of patients originally scheduled between March 10, 2020, and April 30, 2020, were able to complete video visits. Patients who completed video visits were more likely to be white (52% vs 33%; P < .001), English-speaking (96% vs 89%; P = .01), and privately insured (70% vs 54%; P = .004). With TM-based care compared with in-person care, there were significant decreases in environmental and food skin testing completion rates (91% and 92% in 2019 vs 60% and 64% in 2020, respectively, P < .001). Drug allergy testing completed after internal referral remained low but comparable (51% in 2019 vs 52% in 2020). Transitioning nonprocedural visits to video allowed allergen immunotherapy and biologic injection visits to resume at a volume similar to pre-COVID. No COVID-19 infections resulted from in-clinic exposure.

Conclusions: Although transitioning to TM-based care allowed continued A/I care delivery, strategies are needed to achieve higher testing completion rates and ensure video visits do not exacerbate existing health disparities.

Keywords: COVID-19; Health disparity; Telehealth; Telemedicine; Video visit.

Copyright © 2021 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

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Figures

Figure E1

Figure E1

Swim lane diagram for in-person provider visits and procedures pre-COVID for patient, provider, and staff. AH, Antihistamine; DA, drug allergy; FU, follow-up; MA, medical assistant; NP, new patient; PC, patient coordinator; RN, registered nurse; ROS, review of systems; ST, skin testing.

Figure E2

Figure E2

Swim lane diagram for video visits and in-person procedure visits post-COVID for patient, provider, and staff. AH, Antihistamine; DA, drug allergy; FU, follow-up; MA, medical assistant; NP, new patient; PC, patient coordinator; RN, registered nurse; ROS, review of systems; ST, skin testing.

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