Impact of COVID-19 Pandemic on Pediatric Infectious Disease Telehealth Practices in North America.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has driven a significant increase in the use of telehealth (TH) but little is published about changes in TH usage by pediatric infectious disease (PID) providers. We assessed their pre- and intra-pandemic TH usage and experience. METHODS: The Pediatric Infectious Diseases Society Telehealth Work Group surveyed PID specialists in the United States and Canada from 6 December 2020 until 26 February 2021. Data collected included TH modalities, barriers, and satisfaction. RESULTS: The survey response rate was 11.3% (288 of 2,550 PID clinicians) with 243 (96% of 253 analysis-eligible responses) managing children only. Women accounted for 62.1% (n = 157), 51.4% (130) of respondents devoted 50-99% of their time to direct patient care, and 93.3% (236) were located in the United States. The greatest increase in TH usage during the pandemic was in synchronous provider-patient communications (3.9-fold increase). During the pandemic, provider-provider TH increased by less than 10%, comfort with TH usage doubled from 42% to 91%, and satisfaction grew from 74% to 93.3% with different aspects of TH. The top challenge was incomplete or no physical examination (182, 71.9%). Multivariate analysis showed that pre-pandemic TH usage and lack of barriers, but not reimbursement, were significantly associated with higher intra-pandemic usage. EMR-integrated TH was associated with significantly higher usage and satisfaction. Over 70% of respondents anticipate continuing TH usage after the pandemic. CONCLUSIONS: There was high intra-pandemic usage of, and increased comfort and satisfaction with telehealth by PID specialists. Our data help inform post-pandemic TH expectations and strategies.

Pre-Coronavirus Disease 2019 Telehealth Practices Among Pediatric Infectious Diseases Specialists in the United States.

BACKGROUND: Telehealth (TH) practices among pediatric infectious disease (PID) specialists prior to the coronavirus disease 2019 (COVID-19) pandemic are largely unknown. METHODS: In 2019, the Pediatric Infectious Diseases Society (PIDS) Telehealth Working Group surveyed PIDS members to collect data on the use of TH modalities, adoption barriers, interest, extent of curbside consultations (CCs), and reimbursement. RESULTS: Of 1213 PIDS members, 161 (13.3%) completed the survey, and the responses of 154 (12.7%) from the United States were included in our report. Medical school (63.6%) and hospital (44.8%) were the commonest work settings with 16.9% practicing in both of them. The most common TH modalities used were synchronous provider-patient virtual visits (20.8%) and synchronous provider-provider consultations (13.6%). TH services included outpatient consultations (48.1%), vaccine recommendations (43.5%), inpatient consultations (39.6%), and travel advice (39.6%). Barriers perceived by respondents included reimbursement (55.8%), lack of experience with TH (55.2%), lack of institutional support (52.6%), lack of administrative support (50%), and cost of implementation (48.7%). Most of the respondents (144, 93.5%) were interested in implementing a wide range of TH modalities. CCs accounted for 1-20 hours/week among 148 respondents. CONCLUSIONS: Most of the PIDS survey respondents reported low utilization of TH and several perceived barriers to TH adoption before the COVID-19 pandemic. Nonetheless, they expressed a strong interest in adopting different TH modalities. They also reported spending considerable time on non-reimbursed CCs from within and outside their institutions. The results of this survey provide baseline information that will allow comparisons with post-COVID-19 changes in the adoption of TH in PID.

E-prescribing and primary noncompliance: physician and patient experience.

PURPOSE/OBJECTIVES: The success of medication therapy, regardless of how it is prescribed, hinges on patient adherence starting with primary compliance (filling prescriptions.) This study examined primary noncompliance (PNC) in the context of e-prescribing (e-Rx). PRIMARY PRACTICE SETTING: An e-Rx-promotion project was supplemented by mailed alerts to clinicians in private practice regarding PNC to improve adherence to therapy. We included physicians who were willing to participate and plan members who received prescriptions from these providers. Physicians and patients were surveyed about their experience with e-Rx and PNC. FINDINGS/CONCLUSIONS: The rate of PNC was 15%. Provider survey respondents indicated satisfaction with e-Rx (83%.) Most of them were satisfied with improved office efficiency (74%) and certain e-Rx features. Patient survey results indicated that the top 2 reasons for PNC were perception of lack of efficacy and concern about side effects. High cost and absence of symptoms ranked next. Only 34% of patients felt that e-Rx improves medication safety significantly, and many of them were not aware of e-Rx use by their physicians. Most patients and physicians reported being comfortable discussing PNC. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: PNC is a significant cause of poor adherence to drug therapy, and nonfinancial patient concerns are the primary reason. Mailed PNC alerts to providers are resource intensive and may be supplanted by certain e-Rx standards. Clinicians who adopted e-Rx report a largely positive experience with e-Rx. Recent changes in Medicare rules will impact the use of this technology but challenges remain and require continued support to hasten the adoption of e-Rx. Case management programs may improve primary compliance by incorporating exchange of e-Rx data.