Characterizing telemedicine use in clinical immunology and allergy in Canada before the COVID-19 pandemic

Abstract

Rationale There exists a geographic barrier to access CIA care for patients who live in rural communities; telemedicine may bridge this gap in care. Herein we characterized the use of telemedicine in CIA at a population-based level and single centre. Methods Before the COVID-19 pandemic, telemedicine care was provided via the Ontario Telemedicine Network (OTN) in Ontario, Canada. Descriptive data were collected from the OTN administrative database and from electronic medical records at a single academic centre during 2014 to 2019. The potential distance travelled and time saved by telemedicine visits were calculated using postal codes. Results A total of 1298 telemedicine visits was conducted over OTN, with an average of 216 visits per year. Only 11% of the allergists/immunologists used telemedicine to provide care before the COVID-19 pandemic. In the single centre that provided the majority of the telemedicine care, 66% patients were female and the overall mean age was 46. The most common diagnosis was immunodeficiency (40%), followed by asthma (13%) and urticaria (11%). Most patients required at least one follow-up via telemedicine. The average potential two-way distance travelled per visit was 718 km and the average potential time travelled in total was 6.6 h. Conclusion Telemedicine was not widely used by allergists/immunologists in Ontario, Canada before the COVID-19 pandemic. It could offer a unique opportunity to connect patients who live in remote communities and allergists/immunologists who practice in urban centres in Canada. Independent of the current pandemic, our study further highlights the need for more physicians to adopt and continue telemedicine use as well as for healthcare agencies to support its use as a strategic priority once the pandemic is over.

Utility of eConsults for COVID-19 Vaccine-Related Concerns in Ontario: A Cross-Sectional Review

“…This is of particular interest in a time of transition between virtual and in-person care, increased waittimes for specialist consultation, and the known psychological impact this may have on patients (21). As with many other specialties, the general uptake of telemedicine in the eld of CIA was relatively low prior to the COVID-19 pandemic (22), however, emerging data has clearly demonstrated that CIA can effectively and safely implement such a system (5,6). This is of signi cance, as the Canadian Medical Association has only 219 allergists registered as of 2019, with no practicing allergist available in Prince Edward Island, New Brunswick, or the Territories (23).…”

The association between comorbidities and coronavirus disease 2019 hospitalization among people with HIV differs by age

“…The role of immune exhaustion and immune suppression in severe COVID-19 outcomes is becoming more firmly established. Lee et al found that a low CD4 þ /CD8 þ ratio was highly predictive of poor outcomes in COVID-19 and other infectious diseases in the general population [13]. Data from the Center for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort demonstrate that low CD4 þ /CD8 þ ratio and low nadir CD4 þ T-cell count are associated with COVID-19 incidence [26], and older age, no ART, and low CD4 þ T-cell count are associated with intubation and mortality in PWH [12].…”

“…Limitations include retrospective study design, which did not allow for control of all possible confounders. Our study was cross-sectional, and included demographic, clinical, and laboratory data at the time of COVID-19 diagnosis, but we were unable to account for longitudinal variables that may be relevant, including duration of comorbidities, duration of HIV infection, CD4 þ T-cell nadir, or ART history, particularly as CD4 þ T-cell nadir and other markers of immune dysfunction have been associated with poor COVID-19 outcomes [12,13]. Our cohort had an overrepresentation of PWH who were virally suppressed on ART compared with the local HIV epidemic [37], likely a result of persons already engaged in medical care seeking COVID-19 testing and treatment.…”

“…There is mounting evidence, mostly from cohorts of PWH with well controlled HIV in North America and western Europe that an increased comorbidity burden plays a large role in severe COVID-19 risk among PWH [9,10]. Other larger studies from similar settings also implicate HIV-specific parameters including CD4 þ T-cell count, CD4 þ /CD8 þ ratio, HIV-1 RNA viremia, and specific antiretroviral therapy (ART) use [7,[11][12][13]. These data suggest that, while age and comorbidity burden are important contributors to COVID-19 severity among PWH, HIV-related factors, particularly CD4 þ T-cell count, may also play a role.…”

Geographical discrepancy in oral food challenge utilization based on Canadian billing data

“…Generally, access to specialist care in Canada has been limited by their shortage as well as the distance between patients and their physicians. A recent paper published by Lee et al advocated for the use of telemedicine to bridge Allergy and Immunology care to patients with limited access in remote communities [ 13 ].…”