Implementation of Telemedicine in a Laryngology Practice During the COVID-19 Pandemic: Lessons Learned, Experiences Shared

Strohl, Madeleine P.; Dwyer, Christopher D.; Ma, Yue; Rosen, Clark A.; Schneider, Sarah; Young, VyVy N.

doi:10.1016/j.jvoice.2020.06.017

Cited by 26 publications

(43 citation statements)

References 26 publications

(37 reference statements)

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“…Specialties that focus on children or require medical equipment (eg, otorhinolaryngology or ophthalmology) experienced the highest reduction of in-person visits. This is consistent with recent studies that identified a lack of access to laryngoscopes as a downside of telemedicine visits [ 20 ]. Even though telemedicine has provided physicians with an option to deliver outpatient services, the recovery of outpatient clinical activity levels toward 2019 levels differed between specialty groups.…”

Section: Discussionsupporting

confidence: 93%

System-Wide Accelerated Implementation of Telemedicine in Response to COVID-19: Mixed Methods Evaluation

García-Huidobro¹,

Rivera²,

Chang³

et al. 2020

J Med Internet Res

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Background As the COVID-19 pandemic disrupted medical practice, telemedicine emerged as an alternative to outpatient visits. However, it is not known how patients and physicians responded to an accelerated implementation of this model of medical care. Objective The aim of this study is to report the system-wide accelerated implementation of telemedicine, compare patient satisfaction between telemedicine and in-person visits, and report provider perceptions. Methods This study was conducted at the UC Christus Health Network, a large private academic health network in Santiago, Chile. The satisfaction of patients receiving telemedicine care in March and April 2020 was compared to those receiving in-person care during the same period (concurrent control group) as well as in March and April 2019 (retrospective control group). Patient satisfaction with in-person care was measured using the Net Promoter Score (NPS) survey. Patient satisfaction with telemedicine was assessed with an online survey assessing similar domains. Providers rated their satisfaction and responded to open-ended questions assessing challenges, strategies used to address challenges, the diagnostic process, treatment, and the patient-provider relationship. Results A total of 3962 patients receiving telemedicine, 1187 patients from the concurrent control group, and 1848 patients from the retrospective control group completed the surveys. Satisfaction was very high with both telemedicine and in-person services. Overall, 263 physicians from over 41 specialties responded to the survey. During telemedicine visits, most providers felt their clinical skills were challenged (61.8%). Female providers felt more challenged than male providers (70.7% versus 50.9%, P=.002). Surgeons, obstetricians, and gynecologists felt their clinical skills were challenged the least, compared to providers from nonsurgical specialties (P<.001). Challenges related to the delivery modality, diagnostic process, and patient-provider relationship differed by provider specialty (P=.046, P<.001, and P=.02, respectively). Conclusions Telemedicine implemented in response to the COVID-19 pandemic produced high patient and provider satisfaction. Specialty groups perceived the impact of this new mode of clinical practice differently.

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Section: Discussionsupporting

confidence: 93%

System-Wide Accelerated Implementation of Telemedicine in Response to COVID-19: Mixed Methods Evaluation

García-Huidobro¹,

Rivera²,

Chang³

et al. 2020

J Med Internet Res

View full text Add to dashboard Cite

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“…Video‐enabled telemedicine can provide helpful preliminary information such as global swallowing function and change in voice quality/aspiration symptoms after swallow. 24 However, accurate diagnosis often requires additional assessments including laryngoscopy along with modified barium swallow study, CT or MRI. Conservative management with acceptable benefit‐to‐risk ratios was often recommended empirically including dietary and behavioral management of reflux, proton pump inhibitors, H2‐blockers, alginates, antibiotics, and steroids based on appropriate history and preliminary diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Utility of Telemedicine for Diagnosis and Management of Laryngology‐Related Complaints during COVID‐19

Choi

Yin

et al. 2021

The Laryngoscope

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Objectives/Hypothesis To investigate the concordance in diagnosis and management between initial telemedicine visits and subsequent in‐person visits with laryngoscopy for laryngology‐related complaints during COVID‐19. Study Design Retrospective cohort study. Methods Patients who presented to a tertiary care center with laryngology‐related complaints (voice, swallowing, airway, general throat complaints and others) and completed initial telemedicine visits and subsequent in‐person visits with laryngoscopy between March and October 2020 were included (n = 250). Preliminary diagnoses and managements provided during initial telemedicine visits were compared with the diagnoses and managements during subsequent in‐person visits with laryngoscopy. Multivariable logistic regression analysis was performed to compare concordance rates in diagnosis and management by chief complaint categories after adjusting for relevant demographic and clinical factors. Results Overall concordance rates in diagnosis and management between the initial telemedicine visit and subsequent laryngoscopy exam were 86.1% and 93.7%, respectively. Mean (standard deviation) days until laryngoscopy from the initial visit were 21.2 (23.0). Concordance rates were not associated with patient's age, gender, preferred language, provider, telemedicine visit duration, or days until laryngoscopy. Management concordance rate was relatively lower among patients with general throat complaints in comparison with voice‐related complaints (odds ratio: 0.27; 95% confidence interval: 0.08–0.90). Management changes after laryngoscopy included need for further imaging, procedures, voice therapy, and referral to other specialists. Conclusion Concordance rates in diagnosis and management remained high between the initial telemedicine visit and subsequent in‐person visit with laryngoscopy for new patients presenting with laryngology‐related complaints during the COVID‐19 pandemic. While laryngoscopy is still essential to confirm diagnosis and provide appropriate management, telemedicine may be a feasible alternative to provide suitable empiric therapy until laryngoscopy can be safely performed. Level of Evidence Level IV Laryngoscope , 2021

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“…Across 172 completed screenings, 110 patient needs were identified of which 21% (36) were psychosocial/practical, 10% (17) were nutritional, 11% (19) were related to anxiety, 9% (16) were related to physical function, 6% (10) were related to depression, 4% (7) were related to pain interference, and 3% (5) were related to fatigue (Table 2). Across all domains, a higher percentage of patients screened telephonically reported symptoms severe enough to trigger an alert when compared to those who completed the screener on their own through MyChart, as seen in Table 2.…”

Section: Resultsmentioning

confidence: 99%

“…17,18 The onset of the COVID-19 pandemic required rapid responses to changing in-clinic workflows and a shift to increased telehealth visits. Strohl et al 19 suggest telemedicine carries limitations in the ability to conduct a thorough physical exam and other investigations. Capturing data is of utmost importance during a telemedicine visit, particularly during the pandemic when the ability to capture PROMs during in-person clinic visits was limited.…”

mentioning

confidence: 99%

Symptom and needs assessment screening in oncology patients: Alternate outreach methods during COVID-19

Davis

Wilbur

Metzger

et al. 2021

Journal of Psychosocial Oncology

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Patients with cancer are ideally screened for symptoms, including distress, using patient-reported outcome measures (PROMs). This initiative was developed to ensure patients without access to an electronic portal were screened for distress and related symptoms during the COVID-19 pandemic. Prior to the pandemic, these patients could complete screening in clinic. However, many visits transitioned to telehealth. We implemented a standardized telephone outreach process targeting patients without active electronic portal accounts to improve remote symptom monitoring. Outreach resulted in 172 completed screens, identifying 110 needs for 63 individuals. Twentyeight patients completed patient portal enrollment. Outreach calls captured a higher percentage of Black patients (34%) and a higher percentage of 61-80 year olds (69%) compared to portal users. Telephone outreach during the pandemic captured data that otherwise would have been missed in elderly and minority patients without electronic patient portal access. Patient engagement is vital to the distress screening process.

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Implementation of Telemedicine in a Laryngology Practice During the COVID-19 Pandemic: Lessons Learned, Experiences Shared

Cited by 26 publications

References 26 publications

System-Wide Accelerated Implementation of Telemedicine in Response to COVID-19: Mixed Methods Evaluation

System-Wide Accelerated Implementation of Telemedicine in Response to COVID-19: Mixed Methods Evaluation

Utility of Telemedicine for Diagnosis and Management of Laryngology‐Related Complaints during COVID‐19

Symptom and needs assessment screening in oncology patients: Alternate outreach methods during COVID-19

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