Effects of COVID-19 on telemedicine practice patterns in outpatient otolaryngology

Abstract

Objective Otolaryngology is considered high risk for Coronavirus Disease 2019 (COVID-19) exposure and spread. This has led to a transition to telemedicine and directly impacts patient volume, evaluation and management practices. The objective of this study is to determine the impact of COVID-19 on patient characteristics in relation to outpatient attendance, ancillary testing, medical therapy, and surgical decision making. Methods A retrospective case series at an academic medical center was performed. Outpatient appointments from October 2019 (pre-COVID) and March 16–April 10, 2020 (COVID) were analyzed. Prevalence rates and odds ratios were used to compare demographics, visit characteristics, ancillary tests, medication prescribing, and surgical decisions between telemedicine and in-person visits, before and during COVID. Results There was a decrease in scheduled visits during the COVID timeframe, for both in-person and telemedicine visits, with a comparable proportion of no-shows. There was a higher overall percentage of Hispanic/Latino patients who received care during the COVID timeframe (OR = 1.43; 95% CI = 1.07–1.90) in both groups, although primary language was not significantly associated with attendance. There were fewer ancillary tests ordered (OR = 0.54) and more medications prescribed (OR = 1.59) during COVID telemedicine visits compared with pre-COVID in-person visits. Conclusion COVID-19 has rapidly changed the use of telemedicine. Telemedicine can be used as a tool to reach patients with severe disease burden. Continued healthcare reform, expanded access to affordable care, and efficient use of resources is essential both during the current COVID-19 pandemic and beyond. Level of evidence IV.

Real-time remote outpatient consultations in secondary and tertiary care: A systematic review of inequalities in invitation and uptake

“…Xiong’s USA based study reported that patients whose primary language was not English or Spanish were significantly less likely to use remote consultations compared to those whose primary language was English or Spanish (OR 0.34 [95% CI 0.18 to 0.65]; p = 0.001), [ 50 ]. The percentage of patients whose primary language was not English decreased significantly with remote consultations (p<0.001) in the study by Franciosi [ 46 ] but Shehan [ 48 ] reported no significant differences between the groups in the primary languages spoken. Three studies found that those with a first language other than English were less likely to opt for remote consultations but those that did were more likely to choose a telephone consultation than a video consultation [ 37 , 44 , 54 ].…”

“…A retrospective cohort study was the most frequent study design [ 31 , 36 – 41 , 44 , 45 , 47 , 49 , 55 ]. All but one study reported data on participants’ gender [ 49 ], with twenty reporting ethnicity data [ 31 – 33 , 35 – 42 , 44 – 46 , 48 – 51 , 53 , 55 ] and fifteen mean age [ 31 – 35 , 39 , 42 , 46 , 48 , 51 – 54 , 57 , 58 ] ( Table 2 ). Twenty one studies reported data from a single time period [ 31 – 34 , 36 , 37 , 39 , 40 , 42 – 44 , 47 , 49 , 52 – 59 ], and eight reported a comparison of remote consultation uptake rates across two time periods [ 35 , 38 , 41 , 45 , 46 , 48 , 50 , 51 ].…”

“…Eight studies reported that participants who were insured, employed, had higher household income, and a higher educational attainment were more likely to have a remote consultation compared to those with lower household incomes, lower education or who were uninsured [ 31 , 33 , 39 , 44 , 47 , 50 , 56 , 58 ]. Conversely, two studies reported that those on a low income and/or who were uninsured were accepting of technology [ 32 , 48 ]; the difficulty for one study was contacting patients in these groups to offer a remote consultation [ 32 ]. Similarly, Lepage observed that those patients using remote consultations were more likely not to have graduated high school compared to those receiving usual care or mixed method delivery (17% versus 11% versus 14%) (p<0.0001) [ 55 ].…”

“…Data on ethnicity were reported in twenty studies [ 31 – 33 , 35 – 42 , 44 – 46 , 48 – 51 , 53 , 55 ]. Of these one study was based in Australia [ 53 ], one in Canada [ 55 ], and the remainder the USA.…”

“…Language barriers and effect on the uptake of remote consultations were highlighted by nine studies [ 32 , 35 , 37 , 44 , 46 , 48 , 50 , 54 , 56 ]. Adeli found that contacting patients whose first language was not English was problematic, yet once contacted, patients were likely to accept a remote consultation (n = 6/17, 35.3%).…”