Identifying A/I Practice Areas Best Suited For Use of Telemedicine

Telemedicine is an important tool that is being effectivity used in allergy and immunology practice particularly in providing long term asthma care and evaluation of drug allergy. Clinicians have used telehealth to care for both pediatric and adult asthma patients with effective outcomes. These initial studies, discussed below in more detail, show promise indicating that allergists can use telemedicine in their clinical practice to care for almost all kinds of allergy / immunology patients.

Integrating telemedicine into current clinical practice work flow will be different for different providers. Understanding the state requirements for telemedicine use, its limitations and reimbursement policies can help guide the best way to introduce telemedicine to current patients. Providers should investigate whether new or follow up patient evaluations can be done via telemedicine. Another use of telemedicine can be to care for sick visits. Telemedicine sick visit slots can be reserved for a day or week and the number can be increased or decreased according to the demand. These visits can also be used to discuss test results with patients or do routine follow ups for stable patients. Providers can determine at the end of a clinic visit whether the patient will be a good candidate for telemedicine follow up.

References:
ACAAI Position Paper on Use of Telemedicine in Allergy Immunology
Is there a role for telemedicine in adult allergy services?

Use of Telemedicine in Clinical Care
Telemedicine has been shown to effectively provide care for following allergy immunology patients in both adult and pediatric populations.
 

Use of Telemedicine in Asthma in Adults and Children
1. In a recent meta-analysis, combined tele-case management or teleconsultation were effective telemedicine interventions to improve asthma control and quality of life in adults.

Reference:
The Effects of Telemedicine on Asthma Control and Patients' Quality of Life in Adults: A Systematic Review and Meta-analysis.

2. Telemedicine has been used to provide asthma education in medically underserved areas. Scheduled telemedicine visits with certified asthma educators over a period of one year reduced the number for unscheduled visits for asthma.

Reference:
The uses of telemedicine to improve asthma control

3. Telemedicine was shown to be non-inferior to in-person evaluation for asthma care. This is particularly important in medically underserved areas where access to asthma specialist is not readily available. Remote Presence Solution (RPS) equipped with digital stethoscope, otoscope and high-resolution camera was used to perform the visits in this study.

Reference:
Telemedicine is as effective as in-person visits for patients with asthma.

Use of Telemedicine in Management of Drug Allergy
Telemedicine consults were used to identify and consent patients for penicillin skin testing. A certified allergy trained PA conducted the testing and results of the evaluation was communicated in real time to the patient by using telemedicine.

Reference:
The Use of Telemedicine for Penicillin Allergy Skin Testing.

Patient and Provider Satisfaction with Telehealth use in Clinical Care

High provider and patient satisfaction have been noted with telemedicine use in clinical care as it can improve clinical work flow, reduce need for in person patient visits for routine follow ups, urgent visits, and medication refills etc.

1. Provider engagement with telemedicine use
Telehealth setting (hospital-based vs non-hospital and urban vs rural) impacts provider engagement and satisfaction. Providers in urban and hospital setting feel very empowered with telemedicine use. This is likely due to availability of support system and infrastructure availability as compared to non-hospital-based providers and rural providers. Also, the age group of 41-50 is more empowered and satisfied with telehealth use.

References:
Provider Satisfaction with Telehealth: Exploring Variation Across Structural and Demographic Factors
Engaging Physicians in Telehealth
User Satisfaction With Telehealth: Study of Patients, Providers, and Coordinators

2. Patient satisfaction with telemedicine use
Patients reported high satisfaction with telehealth use. One third preferred telehealth visit over traditional visit. Lack of medical insurance increased the odds of preferring telehealth. Predictors of liking telehealth were female gender and being very satisfied with their overall understanding of telehealth, quality of care received, and telehealth's convenience

References:
Telehealth and patient satisfaction: a systematic review and narrative analysis
Primary Care Telemedicine Produces High Patient Satisfaction
User Satisfaction With Telehealth: Study of Patients, Providers, and Coordinators

These links are for research only. They are not endorsed by the American Academy of Allergy, Asthma & Immunology (AAAAI).

1/16/2023