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To see or not to see virtually: QI study of Telehealth practices during the COVID-19 pandemic

Title of Article: Longitudinal Use of Telehealth During the COVID-19 Pandemic and Utility of Asynchronous Testing for Subspecialty-Level Ophthalmic Care

What are the key takeaway points from this article?

This quality improvement study assessed >800,000 patients across 11 surgical subspecialties accessing asynchronous, virtual care during the pandemic. Various retrospective, longitudinal and observational studies assessed the feasibility of virtual care and its future implications. Study main outcomes: What was the percentage of teleophthalmology care in ambulatory care settings? What asynchronous testing can be performed without affecting the quality of care? Specific criteria were set to demonstrate asynchronous testing cut-offs. At its peak, in-patient appointments dropped by 83.3%. Of all ambulatory care visits, telehealth made up 71.2% of care.


Surprisingly, across specialities, the use of virtual care was lowest in ophthalmology. Specialties with the highest virtual care load were gastroenterology, urology, neurosurgery, and neurology. Virtual care in ophthalmology peaked early in the pandemic (31.0%) and slowly returned to exclusively in-person visits (2.0% remained virtual) as restrictions were lifted. Across subspecialties, oculoplastics and pediatric ophthalmology had the highest percentage of virtual care usage and when asynchronous testing was used, it was associated with a 25.4% change in management. This led to new utility such as asynchronous post-operative care.


Asynchronous testing was specific to ophthalmology compared to other specialties. Regarding the patient-reported quality of care outcomes, 91-95% of patients agreed that the physician listened carefully, spent enough time with, and was accessible within 15 mins of an appointment, all favouring virtual care compared to in-person visits.

One of the greatest barriers encountered in teleophthalmology is the inability to perform complete examinations and testing. Further studies and research are needed to tap into the potential that telemedicine offers. This includes research that compares disease progression accuracy in teleophthalmology to traditional practice, determines which barriers exist when training professionals for asynchronous testing, and the generalizability across sub-specialities where microscopic examination is crucial. Lastly, appointed virtual billing codes are critical so that billing does not impede practitioners from offering virtual care visits.


Publication Date: Dec 1, 2022


Reference:

Mosenia A, Li P, Seefeldt R, Seitzman GD, Sun CQ, Kim TN, et al. Longitudinal Use of Telehealth During the COVID-19 Pandemic and Utility of Asynchronous Testing for Subspecialty-Level Ophthalmic Care. JAMA Ophthalmol [Internet]. 2022 Dec 1 [cited 2022 Dec 7]; Available from: https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2799231

Summary by: Brooklyn Rawlyk


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