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Reeves SL, Plegue M, Patel PN, Paulukonis ST, Horiuchi SS, Zhou M, Attell BK, Pace BS, Snyder AB, Plaxco AP, Mukhopadhyay A, Smeltzer MP, Ellimoottil CS, Hulihan M. Assessing Patterns of Telehealth Use Among People with Sickle Cell Disease Enrolled in Medicaid During the Start of the COVID-19 Pandemic. Telemed J E Health 2024; 30:e1971-e1979. [PMID: 38603584 PMCID: PMC11257828 DOI: 10.1089/tmj.2023.0422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024] Open
Abstract
Background: Telehealth can be defined as using remote technologies to provide health care. It may increase access to care among people with sickle cell disease (SCD). This study examined (1) telehealth use, (2) characteristics of telehealth use, and (3) differences between telehealth users and nonusers among people with SCD during the COVID-19 pandemic. Methods: This was a retrospective analysis of Medicaid claims among four states [California (CA), Georgia (GA), Michigan (MI), Tennessee (TN)] participating in the Sickle Cell Data Collection program. Study participants were individuals ≥1 year old with SCD enrolled in Medicaid September 2019-December 2020. Telehealth encounters during the pandemic were characterized by provider specialty. Health care utilization was compared between those who did (users) and did not (nonusers) use telehealth, stratified by before and during the pandemic. Results: A total of 8,681 individuals with SCD (1,638 CA; 3,612 GA; 1,880 MI; and 1,551 TN) were included. The proportion of individuals with SCD that accessed telehealth during the pandemic varied across states from 29% in TN to 80% in CA. During the pandemic, there was a total of 21,632 telehealth encounters across 3,647 users. In two states (MI and GA), over a third of telehealth encounters were with behavioral health providers. Telehealth users had a higher average number of health care encounters during the pandemic: emergency department (pooled mean = 2.6 for users vs. 1.5 for nonusers), inpatient (1.2 for users vs. 0.6 for nonusers), and outpatient encounters (6.0 for users vs. 3.3 for nonusers). Conclusions: Telehealth was frequently used at the beginning of the COVID-19 pandemic by people with SCD. Future research should focus on the context, facilitators, and barriers of its implementation in this population.
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Affiliation(s)
- Sarah L. Reeves
- Department of Pediatrics, Susan B. Meister Child Health
Evaluation and Research Center, Medical School, University of Michigan, Ann Arbor,
Michigan, USA
- Department of Epidemiology, School of Public Health,
University of Michigan, Ann Arbor, Michigan, USA
| | - Melissa Plegue
- Department of Pediatrics, Susan B. Meister Child Health
Evaluation and Research Center, Medical School, University of Michigan, Ann Arbor,
Michigan, USA
| | - Pooja N. Patel
- Department of Pediatrics, Susan B. Meister Child Health
Evaluation and Research Center, Medical School, University of Michigan, Ann Arbor,
Michigan, USA
| | - Susan T. Paulukonis
- Tracking California Program, Public Health Institute,
Oakland, California, USA
| | - Sophia S. Horiuchi
- Tracking California Program, Public Health Institute,
Oakland, California, USA
| | - Mei Zhou
- Georgia Health Policy Center, Andrew Young School of Policy
Studies, Georgia State University, Atlanta, Georgia, USA
| | - Brandon K. Attell
- Georgia Health Policy Center, Andrew Young School of Policy
Studies, Georgia State University, Atlanta, Georgia, USA
| | - Betty S. Pace
- Department of Pediatrics: Hematology/Oncology, Medical
College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Angela B. Snyder
- Georgia Health Policy Center, Andrew Young School of Policy
Studies, Georgia State University, Atlanta, Georgia, USA
| | - Allison P. Plaxco
- Division of Epidemiology, Biostatistics, and Environmental
Health, School of Public Health, University of Memphis, Memphis, Tennessee,
USA
| | - Ayesha Mukhopadhyay
- Division of Epidemiology, Biostatistics, and Environmental
Health, School of Public Health, University of Memphis, Memphis, Tennessee,
USA
| | - Matthew P. Smeltzer
- Division of Epidemiology, Biostatistics, and Environmental
Health, School of Public Health, University of Memphis, Memphis, Tennessee,
USA
| | - Chandy S. Ellimoottil
- Department of Urology, Medical School, University of
Michigan, Ann Arbor, Michigan, USA
| | - Mary Hulihan
- Division of Blood Disorders and Public Health Genomics,
National Center on Birth Defects and Developmental Disabilities, Centers for Disease
Control and Prevention, Atlanta, Georgia, USA
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Hall K, Kafashzadeh D, Chen L, Dudovitz R, Ross MK. Trends in telemedicine visits among pediatric asthma patients during COVID-19. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2024; 3:100239. [PMID: 38577483 PMCID: PMC10992722 DOI: 10.1016/j.jacig.2024.100239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/24/2023] [Accepted: 01/07/2024] [Indexed: 04/06/2024]
Abstract
Background Environmental and social factors, including lack of access to asthma care, contribute to persistent inequities in asthma outcomes among children from historically marginalized ethnoracial groups. Telemedicine, which expanded rapidly during the coronavirus disease 2019 (COVID-19) pandemic, may be an approach to augment access to pediatric asthma care. Objectives We sought to describe characteristics of pediatric (0-17 years) telemedicine users with asthma and characterize use trends throughout the COVID-19 pandemic. Methods We conducted a retrospective analysis using electronic health record data of pediatric patients with asthma seen at University of California, Los Angeles, Medical Center between March 2019 to March 2022 describing telemedicine user characteristics, trends of asthma-related telemedicine use, and associations between user characteristics and having a telemedicine visit. Results Among 6,777 patients with asthma, the percentage of asthma-related telemedicine visits peaked early in the pandemic, comprising 74.3% of visits, before decreasing to 13.6% in 2022. Compared to White patients, Black patients had lower odds of an asthma telemedicine visit (odds ratio [OR], 0.49; 95% confidence interval [CI], 0.26, 0.94). Those with public insurance (OR, 1.7; 95% CI, 1.19, 2.43), severe persistent asthma (OR, 3.03; 95% CI, 1.70, 5.42), or comorbidities (OR, 1.59; 95% CI, 1.08, 2.33) had higher odds. Time to first emergency department visit and hospitalization comparing those with at least one telemedicine visit to those with none were similar. Conclusions More pediatric asthma patients are using telemedicine since the COVID-19 pandemic, particularly those with medical complexity and comorbidities, and outcomes appear similar. However, Black patients at our institution have lower odds of using telemedicine.
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Affiliation(s)
- Kaitlin Hall
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Calif
| | - Dariush Kafashzadeh
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Calif
| | - Lucia Chen
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Calif
| | - Rebecca Dudovitz
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Calif
| | - Mindy K. Ross
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Calif
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Ne CKH, Suaini NHA, Aung WT, Ong KGS, Samuel M, Tham EH. Impact of COVID-19 pandemic on adults and children with atopic dermatitis and food allergy: Systematic review. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2024; 3:100181. [PMID: 38026506 PMCID: PMC10665685 DOI: 10.1016/j.jacig.2023.100181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/26/2023] [Accepted: 08/09/2023] [Indexed: 12/01/2023]
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic caused significant disruptions to health care services and health impacts on patients with atopic dermatitis (AD) and/or food allergy (FA). Objective We evaluated the impact of the COVID-19 pandemic and disease on AD/FA patients. Methods A comprehensive systematic literature search was conducted from December 2019 to 2022. Screening and data extraction were done following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, and the Mixed Methods Appraisal Tool, or MMAT, was used to assess risk of bias. Results In total, 159 studies were included. Five of 7 studies reported no significant changes in overall incidence or prevalence of AD during the pandemic, although some studies noted an increase in the elderly and infants. Telehealth served as an effective alternative to face-to-face consultations, with mixed levels of patient and provider satisfaction. Dissatisfaction was most marked in patients with more severe disease, who thought that their disease was inadequately managed through telemedicine. Higher levels of general anxiety were recorded in both AD/FA patients and caregivers, and it was more pronounced in patients with severe disease. Most studies reported no significant differences in postvaccination adverse effects in AD patients; however, results were more varied in FA patients. Conclusion Our review identified the impact of COVID-19 pandemic- and disease-driven changes on AD/FA patients. Telemedicine is uniquely suited to manage atopic diseases, and hybrid care may be a suitable approach even in the postpandemic era. COVID-19 vaccines and biologics can be safely administered to patients with atopic diseases, with appropriate patient education to ensure continued care for high-risk patients.
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Affiliation(s)
| | - Noor Hidayatul Aini Suaini
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A∗STAR), Singapore, Republic of Singapore
| | - Win Thu Aung
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
| | | | - Miny Samuel
- Research Support Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
| | - Elizabeth Huiwen Tham
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A∗STAR), Singapore, Republic of Singapore
- Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
- Khoo Teck Puat-National University Children’s Medical Institute, National University Health System (NUHS), Singapore, Republic of Singapore
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Williams PV, Fasano MB, Fleisher T. Preparing the Allergist/Immunologist for the Next Pandemic. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:3373-3379. [PMID: 37541618 DOI: 10.1016/j.jaip.2023.07.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/18/2023] [Accepted: 07/21/2023] [Indexed: 08/06/2023]
Abstract
The COVID-19 pandemic had a profound impact on society in general and allergists' practices in particular. The adverse effects included a loss of practice productivity and income, staffing, and in-office procedures due to concerns about the spread of infection and the need for social/physical distancing as well as isolation. Allergy training programs and research activities also suffered. Federal financial assistance, rapid adoption of telehealth with Medicare waivers, and adaptation of practice sites, training programs, and research activities allowed for some return to normal, although still with significant restrictions in staffing and in-office procedures. There were positive aspects to the pandemic in the form of telehealth initiatives, pathways for rapid development and approval of tests and treatments, opportunities for new collaborations, and expertise in vaccines. Preparation for the next pandemic needs to be considered now to avoid the mistakes and missteps that occurred with the COVID-19 pandemic. On a national level, a strategy to overcome the societal divisions, misinformation/disinformation, and distrust of science needs to be developed based on better communication, as well as advocacy for continued improvement in our public health system. Practices and training programs as well as research centers need to institutionalize changes made during the pandemic so they can quickly be reinitiated when necessary.
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Affiliation(s)
- Paul V Williams
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Wash.
| | - Mary Beth Fasano
- Internal Medicine and Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Thomas Fleisher
- Clinical Center, National Institutes of Health, Bethesda, Md
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Wise SK, Damask C, Roland LT, Ebert C, Levy JM, Lin S, Luong A, Rodriguez K, Sedaghat AR, Toskala E, Villwock J, Abdullah B, Akdis C, Alt JA, Ansotegui IJ, Azar A, Baroody F, Benninger MS, Bernstein J, Brook C, Campbell R, Casale T, Chaaban MR, Chew FT, Chambliss J, Cianferoni A, Custovic A, Davis EM, DelGaudio JM, Ellis AK, Flanagan C, Fokkens WJ, Franzese C, Greenhawt M, Gill A, Halderman A, Hohlfeld JM, Incorvaia C, Joe SA, Joshi S, Kuruvilla ME, Kim J, Klein AM, Krouse HJ, Kuan EC, Lang D, Larenas-Linnemann D, Laury AM, Lechner M, Lee SE, Lee VS, Loftus P, Marcus S, Marzouk H, Mattos J, McCoul E, Melen E, Mims JW, Mullol J, Nayak JV, Oppenheimer J, Orlandi RR, Phillips K, Platt M, Ramanathan M, Raymond M, Rhee CS, Reitsma S, Ryan M, Sastre J, Schlosser RJ, Schuman TA, Shaker MS, Sheikh A, Smith KA, Soyka MB, Takashima M, Tang M, Tantilipikorn P, Taw MB, Tversky J, Tyler MA, Veling MC, Wallace D, Wang DY, White A, Zhang L. International consensus statement on allergy and rhinology: Allergic rhinitis - 2023. Int Forum Allergy Rhinol 2023; 13:293-859. [PMID: 36878860 DOI: 10.1002/alr.23090] [Citation(s) in RCA: 79] [Impact Index Per Article: 79.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/11/2022] [Accepted: 09/13/2022] [Indexed: 03/08/2023]
Abstract
BACKGROUND In the 5 years that have passed since the publication of the 2018 International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (ICAR-Allergic Rhinitis 2018), the literature has expanded substantially. The ICAR-Allergic Rhinitis 2023 update presents 144 individual topics on allergic rhinitis (AR), expanded by over 40 topics from the 2018 document. Originally presented topics from 2018 have also been reviewed and updated. The executive summary highlights key evidence-based findings and recommendation from the full document. METHODS ICAR-Allergic Rhinitis 2023 employed established evidence-based review with recommendation (EBRR) methodology to individually evaluate each topic. Stepwise iterative peer review and consensus was performed for each topic. The final document was then collated and includes the results of this work. RESULTS ICAR-Allergic Rhinitis 2023 includes 10 major content areas and 144 individual topics related to AR. For a substantial proportion of topics included, an aggregate grade of evidence is presented, which is determined by collating the levels of evidence for each available study identified in the literature. For topics in which a diagnostic or therapeutic intervention is considered, a recommendation summary is presented, which considers the aggregate grade of evidence, benefit, harm, and cost. CONCLUSION The ICAR-Allergic Rhinitis 2023 update provides a comprehensive evaluation of AR and the currently available evidence. It is this evidence that contributes to our current knowledge base and recommendations for patient evaluation and treatment.
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Affiliation(s)
- Sarah K Wise
- Otolaryngology-HNS, Emory University, Atlanta, Georgia, USA
| | - Cecelia Damask
- Otolaryngology-HNS, Private Practice, University of Central Florida, Lake Mary, Florida, USA
| | - Lauren T Roland
- Otolaryngology-HNS, Washington University, St. Louis, Missouri, USA
| | - Charles Ebert
- Otolaryngology-HNS, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Joshua M Levy
- Otolaryngology-HNS, Emory University, Atlanta, Georgia, USA
| | - Sandra Lin
- Otolaryngology-HNS, University of Wisconsin, Madison, Wisconsin, USA
| | - Amber Luong
- Otolaryngology-HNS, McGovern Medical School of the University of Texas, Houston, Texas, USA
| | - Kenneth Rodriguez
- Otolaryngology-HNS, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Ahmad R Sedaghat
- Otolaryngology-HNS, University of Cincinnati, Cincinnati, Ohio, USA
| | - Elina Toskala
- Otolaryngology-HNS, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Baharudin Abdullah
- Otolaryngology-HNS, Universiti Sains Malaysia, Kubang, Kerian, Kelantan, Malaysia
| | - Cezmi Akdis
- Immunology, Infectious Diseases, Swiss Institute of Allergy and Asthma Research, Davos, Switzerland
| | - Jeremiah A Alt
- Otolaryngology-HNS, University of Utah, Salt Lake City, Utah, USA
| | | | - Antoine Azar
- Allergy/Immunology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Fuad Baroody
- Otolaryngology-HNS, University of Chicago, Chicago, Illinois, USA
| | | | | | - Christopher Brook
- Otolaryngology-HNS, Harvard University, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Raewyn Campbell
- Otolaryngology-HNS, Macquarie University, Sydney, NSW, Australia
| | - Thomas Casale
- Allergy/Immunology, University of South Florida College of Medicine, Tampa, Florida, USA
| | - Mohamad R Chaaban
- Otolaryngology-HNS, Cleveland Clinic, Case Western Reserve University, Cleveland, Ohio, USA
| | - Fook Tim Chew
- Allergy/Immunology, Genetics, National University of Singapore, Singapore, Singapore
| | - Jeffrey Chambliss
- Allergy/Immunology, University of Texas Southwestern, Dallas, Texas, USA
| | - Antonella Cianferoni
- Allergy/Immunology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | | | | | - Anne K Ellis
- Allergy/Immunology, Queens University, Kingston, ON, Canada
| | | | - Wytske J Fokkens
- Otorhinolaryngology, Amsterdam University Medical Centres, Amsterdam, Netherlands
| | | | - Matthew Greenhawt
- Allergy/Immunology, Pediatrics, University of Colorado, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Amarbir Gill
- Otolaryngology-HNS, University of Michigan, Ann Arbor, Michigan, USA
| | - Ashleigh Halderman
- Otolaryngology-HNS, University of Texas Southwestern, Dallas, Texas, USA
| | - Jens M Hohlfeld
- Respiratory Medicine, Fraunhofer Institute for Toxicology and Experimental Medicine ITEM, Hannover Medical School, German Center for Lung Research, Hannover, Germany
| | | | - Stephanie A Joe
- Otolaryngology-HNS, University of Illinois Chicago, Chicago, Illinois, USA
| | - Shyam Joshi
- Allergy/Immunology, Oregon Health and Science University, Portland, Oregon, USA
| | | | - Jean Kim
- Otolaryngology-HNS, Johns Hopkins University, Baltimore, Maryland, USA
| | - Adam M Klein
- Otolaryngology-HNS, Emory University, Atlanta, Georgia, USA
| | - Helene J Krouse
- Otorhinolaryngology Nursing, University of Texas Rio Grande Valley, Edinburg, Texas, USA
| | - Edward C Kuan
- Otolaryngology-HNS, University of California Irvine, Orange, California, USA
| | - David Lang
- Allergy/Immunology, Cleveland Clinic, Cleveland, Ohio, USA
| | | | | | - Matt Lechner
- Otolaryngology-HNS, University College London, Barts Health NHS Trust, London, UK
| | - Stella E Lee
- Otolaryngology-HNS, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Victoria S Lee
- Otolaryngology-HNS, University of Illinois Chicago, Chicago, Illinois, USA
| | - Patricia Loftus
- Otolaryngology-HNS, University of California San Francisco, San Francisco, California, USA
| | - Sonya Marcus
- Otolaryngology-HNS, Stony Brook University, Stony Brook, New York, USA
| | - Haidy Marzouk
- Otolaryngology-HNS, State University of New York Upstate, Syracuse, New York, USA
| | - Jose Mattos
- Otolaryngology-HNS, University of Virginia, Charlottesville, Virginia, USA
| | - Edward McCoul
- Otolaryngology-HNS, Ochsner Clinic, New Orleans, Louisiana, USA
| | - Erik Melen
- Pediatric Allergy, Karolinska Institutet, Stockholm, Sweden
| | - James W Mims
- Otolaryngology-HNS, Wake Forest University, Winston Salem, North Carolina, USA
| | - Joaquim Mullol
- Otorhinolaryngology, Hospital Clinic Barcelona, Barcelona, Spain
| | - Jayakar V Nayak
- Otolaryngology-HNS, Stanford University, Palo Alto, California, USA
| | - John Oppenheimer
- Allergy/Immunology, Rutgers, State University of New Jersey, Newark, New Jersey, USA
| | | | - Katie Phillips
- Otolaryngology-HNS, University of Cincinnati, Cincinnati, Ohio, USA
| | - Michael Platt
- Otolaryngology-HNS, Boston University, Boston, Massachusetts, USA
| | | | | | - Chae-Seo Rhee
- Rhinology/Allergy, Seoul National University Hospital and College of Medicine, Seoul, Korea
| | - Sietze Reitsma
- Otolaryngology-HNS, University of Amsterdam, Amsterdam, Netherlands
| | - Matthew Ryan
- Otolaryngology-HNS, University of Texas Southwestern, Dallas, Texas, USA
| | - Joaquin Sastre
- Allergy, Fundacion Jiminez Diaz, University Autonoma de Madrid, Madrid, Spain
| | - Rodney J Schlosser
- Otolaryngology-HNS, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Theodore A Schuman
- Otolaryngology-HNS, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Marcus S Shaker
- Allergy/Immunology, Dartmouth Geisel School of Medicine, Lebanon, New Hampshire, USA
| | - Aziz Sheikh
- Primary Care, University of Edinburgh, Edinburgh, Scotland
| | - Kristine A Smith
- Otolaryngology-HNS, University of Utah, Salt Lake City, Utah, USA
| | - Michael B Soyka
- Otolaryngology-HNS, University of Zurich, University Hospital of Zurich, Zurich, Switzerland
| | - Masayoshi Takashima
- Otolaryngology-HNS, Houston Methodist Academic Institute, Houston, Texas, USA
| | - Monica Tang
- Allergy/Immunology, University of California San Francisco, San Francisco, California, USA
| | | | - Malcolm B Taw
- Integrative East-West Medicine, University of California Los Angeles, Westlake Village, California, USA
| | - Jody Tversky
- Allergy/Immunology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Matthew A Tyler
- Otolaryngology-HNS, University of Minnesota, Minneapolis, Minnesota, USA
| | - Maria C Veling
- Otolaryngology-HNS, University of Texas Southwestern, Dallas, Texas, USA
| | - Dana Wallace
- Allergy/Immunology, Nova Southeastern University, Ft. Lauderdale, Florida, USA
| | - De Yun Wang
- Otolaryngology-HNS, National University of Singapore, Singapore, Singapore
| | - Andrew White
- Allergy/Immunology, Scripps Clinic, San Diego, California, USA
| | - Luo Zhang
- Otolaryngology-HNS, Beijing Tongren Hospital, Beijing, China
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Jones BL, Carter MC, Davis CM, Wang J. Diversity, Equity, and Inclusion: A Decade of Progress? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:116-125. [PMID: 36272720 DOI: 10.1016/j.jaip.2022.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/05/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022]
Abstract
The concepts of diversity, equity, and inclusion are fundamental and more recently heavily discussed within medicine, research, and the larger society. There is increasing awareness that diversity of thoughts, perspectives, and backgrounds yields stronger teams and more effective results. There is also increasing awareness that stark inequities from systemic, institutional, and individual levels exist that limit the baseline opportunities for many populations. To close disparity gaps, broad aspects of diversity and promoting equity are required and efforts must be inclusive of those most marginalized. In this Clinical Commentary, we discuss, "How and If progress has been made in Diversity, Equity, Inclusion within the field of Allergy/Asthma/Immunology in the past decade?" We discuss the current state of clinical practice and what has been revealed over the past 10 years; describe our current workforce and what progress has or has not occurred there; and finally, review the state of scientific and medical research.
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Affiliation(s)
- Bridgette L Jones
- Department of Pediatrics, Section of Allergy, Asthma, Immunology and Division of Pediatric Clinical Pharmacology and Therapeutic Innovation, University of Missouri Kansas City School of Medicine, Children's Mercy Hospital Kansas City, Kansas City, Mo.
| | - Melody C Carter
- Mast Cell Biology Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Carla M Davis
- Division of Immunology, Allergy and Retrovirology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Julie Wang
- Jaffe Food Allergy Institute, Department of Pediatrics, Division of Allergy & Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
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Cvietusa PJ, Goodrich GK, Steiner JF, Shoup JA, King DK, Ritzwoller DP, Shetterly SM, Bender BG. Transition to Virtual Asthma Care During the COVID-19 Pandemic: An Observational Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:1569-1576. [PMID: 35263682 PMCID: PMC8898589 DOI: 10.1016/j.jaip.2022.02.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND The COVID-19 pandemic increased reliance on virtual care for patients with persistent asthma. OBJECTIVE This retrospective cohort study assessed changes from in-person to virtual care during the pandemic. In patients with persistent asthma, compared with the same period before the pandemic. METHODS Kaiser Permanente Colorado members aged 18 to 99 years with persistent asthma were evaluated during two periods (March to October 2019 and March to October 2020). Comparison of asthma exacerbations (hospitalizations, emergency department visits, and courses of oral prednisone) and asthma medication metrics were evaluated between the two periods and by type of care received during the pandemic (no care, virtual care only, in-person care only, or a mix of virtual and in-person care). Population characteristics by type of care received during the pandemic were also evaluated. RESULTS Among 7,805 adults with persistent asthma, those who used more virtual care or sought no care during the pandemic were younger and had fewer comorbidities, mental health diagnoses, or financial barriers. Exacerbations decreased (0.264 to 0.214; P <.001) as did courses of prednisone (0.213 to 0.169). Asthma medication adherence (0.53 to 0.54; P <.001) and the asthma medication ratio, a quality-of-care metric (0.755 to 0.762; P = .019), increased slightly. Patients receiving a mix of in-person and virtual care had the highest rate of exacerbations (0.83) and a lower asthma medication ratio (0.74) despite having the highest adherence (.57). CONCLUSIONS Despite an increase in virtual care, asthma exacerbations decreased except among individuals who received both in-person and virtual care, likely because they had more severe disease.
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Affiliation(s)
- Peter J. Cvietusa
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colo,Department of Asthma, Allergy, and Immunology, Permanente Medical Group, Denver, Colo,Corresponding author: Peter J. Cvietusa, MD, Department of Asthma, Allergy, and Immunology, Colorado Permanente Medical Group, Kaiser Permanente Colorado, 10400 East Alameda Ave, Denver, Colo 80247
| | - Glenn K. Goodrich
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colo
| | - John F. Steiner
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colo
| | - Jo Ann Shoup
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colo
| | - Diane K. King
- Center for Behavioral Health Research and Services, Institute of Social and Economic Research, University of Alaska Anchorage, Anchorage, Alaska
| | | | | | - Bruce G. Bender
- Division of Pediatric Behavioral Health, National Jewish Health, Denver, Colo
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8
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Patient and Clinician Attitudes Toward Telemedicine for Allergy and Immunology. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY: IN PRACTICE 2022; 10:2493-2499. [PMID: 35618214 PMCID: PMC9124630 DOI: 10.1016/j.jaip.2022.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/09/2022] [Accepted: 05/11/2022] [Indexed: 01/02/2023]
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Eger K, Paroczai D, Bacon A, Schleich F, Sergejeva S, Bourdin A, Vachier I, Zervas E, Katsoulis K, Papapetrou D, Kostikas K, Csoma Z, Heffler E, Canonica GW, Grisle I, Bieksiene K, Palacionyte J, Ten Brinke A, Hashimoto S, Smeenk FWJM, Braunstahl GJ, van der Sar S, Mihălţan F, Nenasheva N, Peredelskaya M, Zvezdin B, Čekerevac I, Hromiš S, Ćupurdija V, Lazic Z, Milenkovic B, Dimic-Janjic S, Yasinska V, Dahlén B, Bossios A, Lazarinis N, Aronsson D, Egesten A, Munir AKM, Ahlbeck L, Janson C, Škrgat S, Edelbaher N, Leuppi J, Jaun F, Rüdiger J, Pavlov N, Gianella P, Fischer R, Charbonnier F, Chaudhuri R, Smith SJ, Doe S, Fawdon M, Masoli M, Heaney L, Haitchi HM, Kurukulaaratchy R, Fulton O, Frankemölle B, Gibson T, Needham K, Howarth P, Djukanovic R, Bel E, Hyland M. The effect of the COVID-19 pandemic on severe asthma care in Europe: will care change for good? ERJ Open Res 2022; 8:00065-2022. [PMID: 35582679 PMCID: PMC8994963 DOI: 10.1183/23120541.00065-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/09/2022] [Indexed: 11/18/2022] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has put pressure on healthcare services, forcing the reorganisation of traditional care pathways. We investigated how physicians taking care of severe asthma patients in Europe reorganised care, and how these changes affected patient satisfaction, asthma control and future care. Methods In this European-wide cross-sectional study, patient surveys were sent to patients with a physician-diagnosis of severe asthma, and physician surveys to severe asthma specialists between November 2020 and May 2021. Results 1101 patients and 268 physicians from 16 European countries contributed to the study. Common physician-reported changes in severe asthma care included use of video/phone consultations (46%), reduced availability of physicians (43%) and change to home-administered biologics (38%). Change to phone/video consultations was reported in 45% of patients, of whom 79% were satisfied or very satisfied with this change. Of 709 patients on biologics, 24% experienced changes in biologic care, of whom 92% were changed to home-administered biologics and of these 62% were satisfied or very satisfied with this change. Only 2% reported worsening asthma symptoms associated with changes in biologic care. Many physicians expect continued implementation of video/phone consultations (41%) and home administration of biologics (52%). Conclusions Change to video/phone consultations and home administration of biologics was common in severe asthma care during the COVID-19 pandemic and was associated with high satisfaction levels in most but not all cases. Many physicians expect these changes to continue in future severe asthma care, though satisfaction levels may change after the pandemic.
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Affiliation(s)
- Katrien Eger
- Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
- Co-first authors
| | - Dora Paroczai
- Csongrad County Hospital and Dept of Pulmonology, University of Szeged, Szeged, Hungary
- Co-first authors
| | - Alison Bacon
- School of Psychology, University of Plymouth, Plymouth, UK
| | | | | | - Arnaud Bourdin
- PhyMedExp, CHU Montpellier, University of Montpellier, Montpellier, France
| | - Isabelle Vachier
- PhyMedExp, CHU Montpellier, University of Montpellier, Montpellier, France
| | | | | | | | | | - Zsuzsanna Csoma
- National Koranyi Institute for Pulmonology, Budapest, Hungary
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy - IRCCS Humanitas Research Hospital - Rozzano (MI), Italy
- Departmento of Biomedical Sciences - Humanitas University - Pieve Emanuele (MI), Italy
| | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy - IRCCS Humanitas Research Hospital - Rozzano (MI), Italy
- Departmento of Biomedical Sciences - Humanitas University - Pieve Emanuele (MI), Italy
| | | | | | | | | | - Simone Hashimoto
- Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | | | | | | | | | - Natalia Nenasheva
- Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation
| | - Marina Peredelskaya
- Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation
| | - Biljana Zvezdin
- Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
- Medical Faculty Novi Sad, University of Novi Sad, Bucharest, Romania
| | - Ivan Čekerevac
- Clinic for Pulmonology, University Clinical Center Kragujevac, Kragujevac, Serbia
- Dept of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Sanja Hromiš
- Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Vojislav Ćupurdija
- Clinic for Pulmonology, University Clinical Center Kragujevac, Kragujevac, Serbia
- Dept of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Zorica Lazic
- Clinic for Pulmonology, University Clinical Center Kragujevac, Kragujevac, Serbia
- Dept of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Branislava Milenkovic
- Clinic for Pulmonology, University Clinical Center of Serbia, Belgrade Medical faculty, Belgrade, Serbia
| | - Sanja Dimic-Janjic
- Clinic for Pulmonology, University Clinical Center of Serbia, Belgrade Medical faculty, Belgrade, Serbia
| | - Valentyna Yasinska
- Karolinska Severe Asthma Center, Dept of Respiratory Medicine and Allergy, Karolinska University Hospital, Huddinge and Dept of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Barbro Dahlén
- Karolinska Severe Asthma Center, Dept of Respiratory Medicine and Allergy, Karolinska University Hospital, Huddinge and Dept of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Apostolos Bossios
- Karolinska Severe Asthma Center, Dept of Respiratory Medicine and Allergy, Karolinska University Hospital, Huddinge and Dept of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Nikolaos Lazarinis
- Karolinska Severe Asthma Center, Dept of Respiratory Medicine and Allergy, Karolinska University Hospital, Huddinge and Dept of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - David Aronsson
- Respiratory Medicine and Allergology, Dept of Clinical Sciences Lund, Lund University and Skåne University Hospital, Lund, Sweden
| | - Arne Egesten
- Respiratory Medicine and Allergology, Dept of Clinical Sciences Lund, Lund University and Skåne University Hospital, Lund, Sweden
| | - Abul Kashem Mohammad Munir
- Respiratory Medicine and Allergology, Dept of Clinical Sciences Lund, Lund University and Skåne University Hospital, Lund, Sweden
| | | | - Christer Janson
- Dept of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Sabina Škrgat
- Dept for Pulmonary Diseases, University Medical Centre Ljubljana, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | | | - Joerg Leuppi
- Medical Faculty University of Basel and Cantonal Hospital Baselland, Liestal, Switzerland
| | - Fabienne Jaun
- Medical Faculty University of Basel and Cantonal Hospital Baselland, Liestal, Switzerland
| | | | - Nikolay Pavlov
- Dept of Pulmonary Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | | | | | | | | | - Simon Doe
- Royal Victoria Infirmary, Newcastle, UK
| | | | | | - Liam Heaney
- Wellcome-Wolfson Centre for Experimental Medicine, Queens University Belfast, Belfast, UK
| | | | | | | | | | | | | | - Peter Howarth
- Global Medical Affairs, Specialty Medicine TA, GSK, Brentford, UK
| | | | - Elisabeth Bel
- Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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Telemedicine in Drug Hypersensitivity. Immunol Allergy Clin North Am 2022; 42:323-333. [DOI: 10.1016/j.iac.2021.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Dhamija Y, Epstein TEG, Bernstein DI. Systemic Allergic Reactions and Anaphylaxis Associated with Allergen Immunotherapy. Immunol Allergy Clin North Am 2021; 42:105-119. [PMID: 34823741 DOI: 10.1016/j.iac.2021.09.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Subcutaneous allergen immunotherapy (SCIT) is a proven treatment of allergic rhinitis, asthma, atopic dermatitis, and prevention of Hymenoptera venom anaphylaxis. The known benefit of SCIT, however, must be considered in each patient relative to the potential risks of systemic allergic reactions (SRs). A mean of 1 SR per 1000 injection visits (0.1%) was estimated to occur between 2008 and 2018. Life-threatening anaphylactic events are estimated to occur in 1/160,000 injection visits. The factors that contribute to SRs and fatal reactions (FRs) are reviewed. Risk management strategies are proposed to prevent and decrease future SCIT associated with SRs, anaphylaxis, and FR.
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Affiliation(s)
- Yashu Dhamija
- Division of Immunology, Allergy and Rheumatology, University of Cincinnati College of Medicine, 231 Albert Sabin Way, ML 0563, Medical Science Bldg. (MSB), Rm 7409, Cincinnati, OH 45267-0563, USA.
| | - Tolly E G Epstein
- Division of Immunology, Allergy and Rheumatology, University of Cincinnati College of Medicine, 231 Albert Sabin Way, ML 0563, Medical Science Bldg. (MSB), Rm 7409, Cincinnati, OH 45267-0563, USA; Allergy Partners of Central Indiana, 7430 N Shadeland Ave, Suite 150, Indianapolis, IN 46250, USA
| | - David I Bernstein
- Division of Immunology, Allergy and Rheumatology, University of Cincinnati College of Medicine, 231 Albert Sabin Way, ML 0563, Medical Science Bldg. (MSB), Rm 7409, Cincinnati, OH 45267-0563, USA
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