Impact of Rapid Transition to Telemedicine-Based Delivery on Allergy/Immunology Care During COVID-19

Lulu R Tsao; Stephanie Anne Villanueva; David A Pines; Michele N Pham; Eugene M Choo; Monica C Tang; Iris M Otani

doi:10.1016/j.jaip.2021.04.018

Impact of Rapid Transition to Telemedicine-Based Delivery on Allergy/Immunology Care During COVID-19

J Allergy Clin Immunol Pract. 2021 Jul;9(7):2672-2679.e2. doi: 10.1016/j.jaip.2021.04.018. Epub 2021 Apr 22.

Authors

Lulu R Tsao¹, Stephanie Anne Villanueva², David A Pines², Michele N Pham³, Eugene M Choo³, Monica C Tang³, Iris M Otani³

Affiliations

¹ UCSF Department of Medicine, Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, San Francisco, Calif. Electronic address: lulu.tsao@ucsf.edu.
² UCSF Adult Allergy/Immunology Clinic, San Francisco, Calif.
³ UCSF Department of Medicine, Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, San Francisco, Calif.

Abstract

Background: Coronavirus disease 2019 (COVID-19) necessitated wide-scale adoption of telemedicine (TM) and restriction of in-person care. The impacts on allergy/immunology (A/I) care delivery are still being studied.

Objective: To describe the outcomes of rapid transition to TM-based care (video visit followed by in-person visits dedicated to diagnostic and therapeutic procedures when needed) at an academic A/I practice during COVID-19.

Methods: Demographic data were compared for patients originally scheduled for in-person visits between March 10, 2020, and April 30, 2020, who completed a video visit instead between March 10, 2020, and June 30, 2020, and those who did not. Appointment completion, diagnoses, and drug allergy and skin testing completion were compared for visits between March 10, 2020, and June 30, 2020, and 1 year prior (March 10, 2019-June 30, 2019).

Results: Sixty-nine percent (265 of 382) of patients originally scheduled between March 10, 2020, and April 30, 2020, were able to complete video visits. Patients who completed video visits were more likely to be white (52% vs 33%; P < .001), English-speaking (96% vs 89%; P = .01), and privately insured (70% vs 54%; P = .004). With TM-based care compared with in-person care, there were significant decreases in environmental and food skin testing completion rates (91% and 92% in 2019 vs 60% and 64% in 2020, respectively, P < .001). Drug allergy testing completed after internal referral remained low but comparable (51% in 2019 vs 52% in 2020). Transitioning nonprocedural visits to video allowed allergen immunotherapy and biologic injection visits to resume at a volume similar to pre-COVID. No COVID-19 infections resulted from in-clinic exposure.

Conclusions: Although transitioning to TM-based care allowed continued A/I care delivery, strategies are needed to achieve higher testing completion rates and ensure video visits do not exacerbate existing health disparities.

Keywords: COVID-19; Health disparity; Telehealth; Telemedicine; Video visit.

MeSH terms

Ambulatory Care Facilities
COVID-19*
Humans
Hypersensitivity*
SARS-CoV-2
Telemedicine*