Incorporation of telemedicine by rhinologists: The COVID-19 pandemic and beyond

Assessing feasibility and satisfaction in third-trimester pre-anaesthetic teleconsultations: A prospective observational study

Background and Aims

Pregnancy presents risks, particularly for women with pre-existing health problems. Pre-anaesthetic consultations can help anticipate these risks and establish a medical management strategy on the delivery day. While teleconsultations gained popularity during the coronavirus disease 2019 (COVID-19) pandemic, research on pre-anaesthetic teleconsultations during pregnancy is limited. This study aimed to assess patient satisfaction and physician perception of teleconsultations for third-trimester pre-anaesthetic consultations.

Methods

A prospective observational study included pregnant women who opted for teleconsultations for pre-anaesthetic consultations. Patient satisfaction was assessed using Likert scale questions and the System Use Scale. Anaesthetist satisfaction was evaluated using a Likert scale and by considering changes in anaesthetic techniques and missing clinical data in the pre-anaesthetic assessment. Data analysis utilised SPSS Statistics for Windows, Version 20.0. encompassing descriptive statistics, hypothesis testing and odds ratio calculations. This approach explored the correlation between patient and anaesthetist satisfaction and pertinent risk factors.

Results

The study enroled 99 patients, with 85% expressing satisfaction and high satisfaction on the Likert scale and 88% finding the teleconsultation acceptable based on the System Use Scale (score ≥ 70). Anaesthetists reported being satisfied with the pre-anaesthetic consultations in 94% of cases.

Conclusion

This study demonstrates the feasibility and effectiveness of telemedicine consultations in obstetric anaesthesia, showing high patient and anaesthetist satisfaction rates.

Otolaryngology Patient Satisfaction with In-Office Appointments and Virtual Visits Due to COVID-19

BACKGROUND

The COVID-19 pandemic forced otolaryngologists to seek new methods of providing patient care in a remote setting. The effect of this paradigm shift on patient satisfaction, however, remains unelucidated. This study compares patient satisfaction with telehealth visits during the COVID-19 pandemic to that with in-office visits during the same period in 2019.

METHODS

Press Ganey survey responses of patients seen by otolaryngologists within a large, academic, multicenter hospital system were gathered. Responses were included in analyses if they corresponded with a visit that occurred either in clinic March to December 2019 or via telehealth March to December 2020. Chi-Square Test of Independence and Fisher's Exact Test were employed to detect differences between years. Binary logistic regressions were performed to detect the factors most predictive of positive telehealth experiences.

RESULTS

Patient overall satisfaction with in-office and telehealth visits did not differ significantly (76.4% in 2019 vs 78.0% in 2020 rated visit overall as "very good," P = .09). Patients seen by a Head and Neck (odds ratio 4.13, 95% confidence interval 1.52-11.26, P = .005), Laryngology (OR 5.96, 95% CI 1.51-23.50, P = .01), or Rhinology (OR 4.02, 95% CI 1.55-10.43, P = .004) provider were significantly more likely to report a positive telehealth experience.

CONCLUSIONS

Patients seen via telehealth during COVID-19 reported levels of satisfaction similar to those seen in-office the year prior. These telehealth satisfaction levels, however, are contextualized within the expected confines of a pandemic. Further research is required to determine whether satisfaction remains consistent as telemedicine becomes a ubiquitous component of medical practice.

COVID-19 and rhinological surgery

The Coronavirus-19 (COVID-19) pandemic has caused disruptions in the normal patient care workflow, necessitating adaptations within the healthcare profession. The objective of this article is to outline some of these adaptations and considerations necessitated by COVID-19 within the subspeciality of rhinology and endoscopic skull base surgery.

Telemedicine and Telementoring in Rhinology, Otology, and Laryngology: A Scoping Review

Objective

Telemedicine and telementoring have had a significant boost across all medical and surgical specialties over the last decade and especially during the COVID-19 pandemic. The aim of this scoping review is to synthesize the current use of telemedicine and telementoring in otorhinolaryngology and head and neck surgery.

Data Sources

PubMed and Cochrane Library.

Review Methods

A scoping review search was conducted, which identified 469 articles. Following full-text screening by 2 researchers, 173 articles were eligible for inclusion and further categorized via relevant subdomains.

Conclusions

Virtual encounters and telementoring are the 2 main applications of telemedicine in otolaryngology. These applications can be classified into 7 subdomains. Different ear, nose, and throat subspecialties utilized certain telemedicine applications more than others; for example, almost all articles on patient engagement tools are rhinology based. Overall, telemedicine is feasible, showing similar concordance when compared with traditional methods; it is also cost-effective, with high patient and provider satisfaction.

Implications for Practice

Telemedicine in otorhinolaryngology has been widely employed during the COVID-19 pandemic and has a huge potential, especially with regard to its distributing quality care to rural areas. However, it is important to note that with current exponential use, it is equally crucial to ensure security and privacy and integrate HIPAA-compliant systems (Health Insurance Portability and Accountability Act) in the big data era. It is expected that many more applications developed during the pandemic are here to stay and will be refined in years to come.

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

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

4 Laryngoscope, 132:831–837, 2022

[Impact of the COVID-19 pandemic on consultations and diagnosis in ENT practices in Germany]

OBJECTIVE

During the first months of the COVID-19 pandemic, there was a significant reduction in the frequency of visits to healthcare institutions. This circumstance influenced the timely diagnosis and subsequential initiation of therapy in almost all specialties. The aim of the present study is to evaluate a hypothetical change in health awareness with regard to outpatient consultations of ENT physicians in Germany.

MATERIAL AND METHODS

This study used anonymized data from 146 ENT practices in Germany and included 162,724 patients in Q2 2019, 158,077 in Q3 2019, 128,342 in Q2 2020, and 149,153 in Q3 2020. The first outcome was the difference in the number of patients with at least one visit to these practices between the second and third quarters of 2019 and the second and third quarters of 2020. The second outcome was the number of patients with new diagnoses per practice, defined as diagnoses not previously documented in the database for a given patient.

RESULTS

The number of patients per practice was significantly lower in Q2 2020 compared to Q2 2019 (879 versus 1108, p<0.001). There were no significant differences when comparing Q3 2020 to Q3 2019 (1022 versus 1083, p=0.261). Diagnoses of otitis media (-43%), acute upper respiratory tract infections (-42%), chronic upper respiratory tract diseases: (-21%), hearing loss (-20%) decreased significantly in Q2 2020 compared to Q2 2019. There was still a significant decrease in patient numbers for acute upper respiratory tract infections (-26%) and otitis media (-25%) in Q3 2020 compared to Q3 2019.

CONCLUSIONS

The presented results are attributable to several facts. Avoidance of doctor´s visits by the patients, reduction of allocation of appointments by practices and consistent obeying of distance and hygiene measures in terms of wearing filtering face masks (e.g. FFP2/KN95).

Satisfaction with the use of telehealth during COVID-19: An integrative review

Background

The novel coronavirus (COVID-19) pandemic has defined 2020 thus far. Businesses, social and religious gatherings, travel, and almost all forms of transportation shut down to halt the spread of COVID-19. People were ordered to quarantine in place, and the world appears to go into a standstill. In the midst of being quarantined people with acute and chronic conditions still require medical care and treatment. An alternative way for people to receive needed health care was necessary. Hence, we saw an unprecedented surge in telehealth. With this unprecedented surge in use of telehealth, there is matter of delivering quality care.

Objective

Guided by the Donabedian Model, the purpose of this integrative review was to examine current evidence on patient and healthcare provider's satisfaction with the use of telehealth during the COVID-19 pandemic.

Design

An integrative review of the literature.

Data sources

The literature review was conducted utilizing PubMED, CINAHL, Google Scholar and Cochrane Library databases. Inclusion criteria were studies published from January 2020 to July 11, 2020, published and translated in English language, and studies that evaluated patients and providers satisfaction with the use of telehealth or telemedicine during COVID-19. Eighteen articles were included in this review.

Review methods

An evaluation matrix was developed to collect data from the included articles. The articles were appraised using Fineout-Overholt & Gallagher-Ford Rapid Critical Appraisal Checklist for Descriptive Studies and Rapid Critical Appraisal of Evidence-Based Practice Implementation or Quality Improvement Projects (Melnyk & Fineout-Overholt, 2015). Authors independently appraised each article using the appropriate appraisal tools.

Results

Ten of the articles (53%) included were studies conducted in the United States. Sixteen out of 18 studies evaluated patient satisfaction and five studies examined healthcare providers' satisfaction with the use of telehealth. The majority of telehealth services offered were by subspecialists. Overall, patients and healthcare providers have high level of satisfaction with the use of telehealth during COVID-19 pandemic. Many patients and healthcare providers reported willingness to continue using telehealth after the pandemic.

Conclusion

This integrative review provided additional evidence on patient and healthcare provider's satisfaction with the use of telehealth. Findings in this review may not be surprising as individuals, healthcare providers, and health systems needed to adopt the use telehealth due to necessity. However, the results for telehealth are promising.