Utility of telephone visits at an urban safety‐net hospital during 2020: A retrospective review

Abstract

Objective During COVID‐19, otolaryngology clinics rapidly implemented telehealth programs in accordance with social distancing guidelines and institutional policies. Our objectives are to evaluate the usefulness of telephone audio visits for underserved patients seeking otolaryngological care at an urban safety‐net hospital and identify patient factors associated with telephone visit attendance. Methods In a retrospective review of all adult telephone visits in 2020, we compared the demographics and visit characteristics of patients who attended telehealth versus in‐person visits and patients who attended versus missed telehealth visits. Univariable and multivariable regressions were utilized to identify predictors of missing telehealth visits. Results We identified 318 telehealth encounters completed by 254 patients (72.8% were of racial/ethnic minority; 76.3% had low‐income, need‐based insurances; 43.7% had limited English proficiency). The most common chief complaints were related to head and neck oncology ( n = 85, 26.7%), otology/neurotology ( n = 74, 23.3%), and general otolaryngology ( n = 69, 21.7%). The following actions were executed during telephone visits: behavioral and/or medication patient education ( n = 152, 47.8%); sharing testing/imaging/tumor board results ( n = 125, 39.3%); referrals to another department ( n = 103, 32.4%); rendering a new diagnosis ( n = 98, 30.8%); changing medications ( n = 60, 18.9%). Less than half of telephone visits (46.2%) resulted in in‐person follow‐up, most commonly for in‐person exams. The distribution of race/ethnicity differed between attended in‐person appointments versus telephone visits ( p = .01), but race and ethnicity were not significant predictors of telephone visit attendance. Conclusion Despite limited diagnostic capabilities, telephone audio visits can be an effective and accessible tool for providing continuity and advancing care in socially disadvantaged patients. Level of evidence IV.

Patient Characteristics Associated With Being Offered or Choosing Telephone vs Video Virtual Visits Among Medicare Beneficiaries

“…Our finding that 43.1% of patients chose telephone visits when given the option between telephone and video visits underscores the often-overlooked idea that patients may prefer telephone visits in some cases. Telephone visits may also be clinically reasonable for certain scenarios, such as in the treatment of mental health conditions . In further support of potential use cases for telephone visits, an analysis of video and telephone visits at 2 geriatrics clinics found that telephone visits were shorter than video yet included discussion of more diagnoses and were equally likely to include advance care planning …”

“…Telephone visits may also be clinically reasonable for certain scenarios, such as in the treatment of mental health conditions. 22 , 23 , 24 In further support of potential use cases for telephone visits, an analysis of video and telephone visits at 2 geriatrics clinics found that telephone visits were shorter than video yet included discussion of more diagnoses and were equally likely to include advance care planning. 17 …”

“…Telephone visits may also be clinically reasonable for certain scenarios, such as in the treatment of mental health conditions. [22][23][24] In further support of potential use cases for telephone visits, an analysis of video and telephone visits at 2 geriatrics clinics found that telephone visits were shorter than video yet included discussion of more diagnoses and were equally likely to include advance care planning. 17 At the same time, given the likely advantages associated with video visits, we were concerned to find lower rates of video visits being offered and received among historically marginalized groups, consistent with prior studies finding fewer video visits among patients who are older, [7][8][9][10][11][12][13][14][15][16] have lower incomes, 8 are of Hispanic ethnicity, 8,9,16 or have limited English proficiency.…”