RESULTS
Between March 24, 2020 and June 30, 2020, our division completed 3,787
telemedicine visits, with 150 to 300+ visits being conducted per week
from April through June (Figure 1). Beginning in June, in-person visits
started being offered again on a case by case basis, and a hybrid model
of in-person clinic visits and telemedicine video visits was adopted.
There were 788 patients seen for a pulmonary telemedicine visit from May
17,2020 through June 12, 2020. A majority of these patients (67%)
lived in Pennsylvania and nearly 30% lived in New Jersey. Over half of
the patients were male. Nearly 60% of patients identified as being
Caucasian and 25% as being African American. Nearly 90% of patients
did not identify as being Hispanic or Latino. The median age of patients
was 7 years (mean 7.79 years, standard deviation 5.8 years; 25-75% IQR
3-12 years).
Fifty-four (6.9%) patients responded to the survey about their
experience with telemedicine. Six of these patients (11%) had prior
experience with telemedicine in another division. The majority of
patients were previously cared for at the institution’s main clinic site
in Philadelphia (60%) and 40% were previously seen in suburban
subspecialty care centers. Forty-one providers responded to the survey.
Over half of the providers who responded were physicians (Table 1). The
most commonly seen diagnoses were patients with general pulmonary
conditions, sleep-related breathing disorders, and asthma.
All of the providers who responded to the survey indicated they would be
interested in continuing telemedicine in the future, and 46 patients
(85%) indicated that they would be interested in telemedicine after the
pandemic resolved (Figure 2). Both patients and providers were most
interested in future telemedicine use for regular follow-up visits and
to obtain an appointment sooner (Figure 3). Both patients and providers
had a positive telemedicine experience, with 92% of patients rating
their telemedicine experience as excellent or very good and 72% of
providers rating their telemedicine experience as excellent or very good
(Figure 4A). Benefits of telemedicine visits as perceived by patients
and providers are further delineated in Figure 4B and 4C and had some
areas of overlap. Additional comments provided by patients about the
benefits of telemedicine visits were that the “patient does not have to
miss a whole day of school” and it provided access to care for patients
that live in another state by removing “a lot of the financial aspects
of gas/food/hotel.” Providers commented that telemedicine visits
allowed them the ability “to see patients more frequently without them
having to travel [to the appointment]”, provide care to patients
during inclement weather, and improve efficiency and flow “due to a
lack of barriers encountered during in person visits” (e.g. waiting for
rooms to open up, waiting to be triaged).
Specific clinical program providers reported that telemedicine may be
helpful for general pulmonary patients for more frequent follow-up,
families with limited resources, those that live far away, patients that
are clinically stable, instances of inclement weather preventing travel
to appointments, and patients with frequent questions or phone calls. In
the sleep medicine program, survey respondents supported the use of
telemedicine for determining if a sleep study is needed, following up on
sleep study results, non-invasive ventilatory support follow-up, and
behavioral sleep concerns. Providers supported telemedicine visits for
asthma follow-up care in those with historically normal lung function
testing, in children too young to perform spirometry, or patients whose
asthma is well controlled. Cystic fibrosis provider responses identified
telemedicine as a useful method for completing quarterly follow-up
visits alternating with in-person visits. The aerodigestive program
respondents also supported the use of telemedicine for follow-up visits.
The technology dependent center respondents reported that telemedicine
may be useful for respiratory weaning, trouble-shooting ventilator
challenges, and to check on equipment.
The majority of patients (76%) did not perceive significant technical
difficulties during their telemedicine visits (Figure 5A). Providers
cited technical difficulties sometimes with each aspect of telemedicine
including audio, visual, patients not having access to the equipment,
patients forgetting scheduled visits, and patients arriving late (Figure
5B). Providers and patients both expressed limitations in the physical
examination and inability to obtain standard vital signs. Providers also
felt lack of spirometry was a limitation. Both providers and patients
indicated distractions at home or inability for a child to sit for video
visit were limitations. Suggestions provided by patients to improve
telemedicine included being able to use a laptop for the visit rather
than a smart phone. Providers suggested having pre-visit check-in
assistance to help patients work through technology challenges, using a
larger screen for visits, and having improved physical examination
capabilities.