Eligibility for live, interactive otolaryngology telemedicine: 19-Month experience before and during the COVID-19 pandemic in Taiwan

Abstract

Background Unequal access to healthcare is a global medical problem. Telemedicine, recently made possible by technological advances, may mitigate this inequity. However, the usefulness of telemedicine for procedure-driven disciplines, such as otolaryngology, under infectious conditions (e.g., the COVID-19 pandemic) is unknown. Methods Telemedicine was made legal in Taiwan by an amendment to the Physician Act in 2018. Kaohsiung Chang Gung Memorial Hospital was the first hospital in Taiwan to provide the telemedicine service by connecting to the Chenggong Branch of Taitung Hospital (CGBTH) in November 2018. This retrospective cohort study included all new and established otolaryngology outpatient consultations between November 2018 and May 2020 at CGBTH. The Current Procedural Terminology and International Classification of Disease, 10th Revision codes, patient demographic data, and questionnaire data were obtained. Results The study included 123 patients with 218 encounters over 19 months. The majority of complaints were ear-related (52.6%). Overall, 49% of the encounters required a specialized procedure for diagnosis and treatment; of these, cerumen removal was the most common procedure. The patient subjective improvement rate increased over the study period (from 62.0% to 78.9%). The rates of return and case closure were both around 90% in 2018 and 2019. The number of otolaryngology consultations and rate of return declined after the start of the COVID-19 pandemic; however, the subjective improvement and case closure rates remained stable. The telemedicine service saved at least 2 h driving time per visit. Conclusion Telemedicine for otolaryngology is a promising approach for remote and underserved regions, as well as during an infectious disease pandemic.

Clinical signs, telemedicine and online consultations in head and neck diseases during the SARS CoV-2 pandemic: an Italian experience

“…The diagnostic accuracy and effectiveness of empiric therapy provided during TM visits are of particular interest in determining the feasibility of its use in the effective management of patients 14 . A limitation to this type of approach is the need for an adequately trained health care technician to perform diagnostic and minor therapeutic procedures 13 , 15 .…”

“…Wu et al found that the use of TM with the help of a health technician, who can perform the clinical examination and transmit the data in real time to the specialist, was used mostly for ear diagnoses (52.6%). The remaining diagnoses included throat problems (14.1%) and nasal disorders (13.3%), earwax plug (9.2%), chronic otitis externa (8.1%) and otitis media (8.1%) 15 . The same authors noted that a specialised procedure was not required to diagnose and treat 51% of cases; therefore, they were considered suitable for TM, but the eligibility varied depending on the anatomic site.…”

“…The most common procedures were cerumen removal and endoscopic examinations of the larynx and nose. Other procedures included removal of foreign bodies, repositioning manoeuvers and topical treatments 15 .…”

Greek gods and the double-edged sword of liver regeneration

“…performed a retrospective cohort study, looking at the usefulness of telemedicine under infectious conditions in otolaryngology outpatient consultations at a clinic in Taiwan. 2018 legal amendments were performed to further introduce telemedicine in the country, although it has not yet been largely included in otolaryngology routine clinical practice [ 29 ]. While on the one side healthcare can be made more accessible through telemedicine, disadvantages lie in the challenges of the technology itself.…”

“…conclude that remote, face-to-face, real-time otolaryngology telemedicine service is efficient, time-saving and satisfactory for patients as well as healthcare practitioners despite the limiting but often required specialized procedures in the field. Further technological progress will allow a higher patient eligibility and service level [ 29 ].…”