DISCUSSION
The COVID-19 pandemic transformed the role of telemedicine in delivering care to children with pulmonary disorders. Our survey data demonstrate a high level of satisfaction with telemedicine among clinicians, allied health professionals and patients’ families. While other publications exist describing telemedicine experiences during the COVID-19 era in several other pediatric subspecialties4-8, to our knowledge, this is the first study examining the use of telemedicine visits across the full spectrum of conditions treated by pediatric pulmonary and sleep medicine specialists at a large tertiary care center.
This study adds important perspectives regarding the feasibility, acceptability and overall favorability of telemedicine in a field where physical examination has traditionally played an important role in evaluation and management. While digital auscultative capabilities exist, cost and lack of accessibility for many families has constrained its implementation. Despite these limitations, our study demonstrates that telemedicine is a feasible and favorable method of healthcare delivery of pulmonary medicine during the current global health crisis and beyond.
As defined by the Institute of Medicine, patient-centered care involves “providing care that is respectful of and responsive to individual patient preferences, needs and values” and “focuses on the patient’s experience of illness and healthcare and on the systems that work or fail to work to meet individual patients’ needs9.” The patient’s experiences, perspectives and satisfaction are critical components of patient-centered care, and this study assesses these important aspects of telemedicine. The results indicate overwhelmingly positive patient experiences and satisfaction. In healthcare’s ongoing pursuit of providing quality patient-centered care, these will be important markers to continue to monitor to ensure we continue to meet the needs of our patients and their families.
There are several limitations to our data. First, the patient and provider surveys were not administered in an identical fashion. While patients were surveyed in association with a single completed telemedicine visit, providers were surveyed for their overall telemedicine experiences and attitudes from their cumulative encounters with telemedicine since the switch to telemedicine with the COVID-19 pandemic. Second, the patient surveys were only sent to those who completed a telemedicine visit, which could subject our results to bias due to failure to capture data from those who were unable to complete telemedicine visits due to difficulties with technology and/or those who lacked the appropriate resources needed to complete a telemedicine visit (e.g. no smartphones or reliable internet services). Third, the patient surveys were not sent immediately at the conclusion of the visit encounter. While this presents a potential for patients and families to forget some of the details regarding their visit, none of our survey questions relied on recalling specific details of the visit, making it less likely that their responses would differ significantly with this short lapse in time.  Fourth, only 6.9% of patients who were sent a survey responded, thus there is the possibility that our results could be different than if we had received responses from all patients. Finally, our data queried patients and providers for subjective experiences and did not include objective metrics. However, a large component of the patient-centered healthcare model is about the patient experience, so the insights gained from our study offer invaluable information. Future studies are needed to examine the impact of telemedicine on objectively measurable health outcomes.