Successes and challenges of delivering allergy/immunology care via telemedicine
Published online: July 1, 2021
During the COVID-19 pandemic, many allergy/immunology clinics experienced a dramatic shift towards delivering care via telephone and video visits. Many patients may prefer telemedicine beyond COVID-19 for its convenience and reduced travel time. To ensure high-quality, equitable care, it is important to understand how utilizing telemedicine may affect completion of in-person allergy testing and treatments that are critical for successful allergy/immunology care. Additionally, it is important to understand how telemedicine may exacerbate underlying healthcare disparities.
A study by Tsao et. al. published in the July 2021 issue of The Journal of Allergy and Clinical Immunology: In Practice reports one academic medical center’s experience with rapid conversion to telemedicine-based allergy/immunology care. The clinic converted all in-person visits to video visits over the Zoom platform, with medical assistants conducting a pre-visit phone check-in 30 minutes before the visit. Patients who required allergy testing or treatment were scheduled to return for in-person testing and immunotherapy/biologic injection visits as allowed by the COVID-19 surge level. The study collected outcomes on successful conversion from in-person to video visits as well as patients’ demographic factors, diagnoses, and testing completion rates.
From March through June 2020, the overall visit volume and range of diagnoses seen via telemedicine were similar to those seen via in-person visits from March through June 2019, and the no-show rate improved with video visits from 14% to 6%. Patients were able to resume allergen immunotherapy and biologic administration in the clinic at similar rates to pre-COVID-19. However, 31% of the in-person visits originally scheduled during March and April 2020 could not be successfully completed as video visits. Video visit completion was less likely in non-White, non-English-speaking, and Medicaid-insured patient populations. Additionally, only 60-64% of patients seen via telemedicine completed environmental and food allergy skin testing, a significant decrease from pre-COVID-19 rates of 90-92%. The only characteristic associated with skin testing completion was access to an electronic patient portal messaging system.
This study provides insight into the successes and challenges of providing allergy/immunology care via telemedicine and emphasizes the importance of monitoring access to telemedicine through an equity lens. Screening for technology barriers and identifying patients at high risk of being unable to complete video visits may help mitigate disparities. Access to electronic patient portal messaging may improve asynchronous testing completion. For telemedicine to be successful long-term, these potential interventions need to be partnered with support and reimbursement of associated work to prevent physician and staff burn-out.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.