Allergy Service, Department of Medicine, Brooke Army Medical Center, Fort Sam Houston, San Antonio, Texas.
Allergy Service, Division of Medicine, Landstuhl Regional Medical Center, Landstuhl, Germany.
J Allergy Clin Immunol Pract. 2019 Mar;7(3):1017-1021. doi: 10.1016/j.jaip.2018.10.026. Epub 2018 Oct 29.
Although the framework and potential benefits for using telemedicine have been described, allergy-specific outcomes are often limited or have a narrow focus.
To determine the percentage of new and follow-up visits conducted via synchronous telemedicine requiring an in-person visit.
A retrospective review evaluating synchronous tele-allergy appointments in a hospital-based allergy clinic was performed.
A total of 360 unique patients participated in 423 synchronous tele-allergy visits from January 2016 to December 2017; 275 (65.0%) were new consultations, 54% were males, and 118 (28%) visits were for children. Allergic rhinitis (35%), asthma (24%), and food allergy (10%) represented the top 3 diagnoses. New and follow-up tele-allergy visits accounted for 13.1% (275 of 2097) and 10.4% (148 of 1426) of all outpatient visits during the study period, respectively. Sixty-five (23.4%) new patients and 14 (9.5%) follow-up patients were recommended for an in-person appointment (P < .001). Compared with follow-up tele-allergy visits, new visits were more likely to have medication prescribed (64.4% vs 49.0%; P < .002) and laboratory tests ordered (46.2% vs 7.4%; P < .001); there were no differences between new and follow-up tele-allergy visits for mean study observation period (P = .680), subsequent in-person visits conducted on the basis of provider recommendation (P = .120), or telephone consultations (P = .190). One hundred forty (33.1%) patients completed an anonymous satisfaction survey, with 98.8% of patients recommending telehealth and reporting high satisfaction. On the basis of 423 visits from 13 originating sites, patients saved an average of $485 in travel expenses, 438 driving miles, and 2.3 days of work or school per visit.
Coupled with high patient satisfaction and significant time and cost savings, tele-allergy supported most of the new and follow-up visits without an in-person recommendation. Although not all tele-allergy efforts incorporate a synchronous modality with a dedicated patient presenter, allergists should continue to seek opportunities to incorporate synchronous tele-allergy with a trained patient presenter into their clinical practice.
尽管已经描述了使用远程医疗的框架和潜在益处，但过敏相关的具体结果往往有限或关注面较窄。
确定通过同步远程医疗进行的新诊和随诊就诊中需要进行面对面就诊的比例。
对 2016 年 1 月至 2017 年 12 月在一家医院过敏诊所进行的同步远程过敏预约进行了回顾性评估。
共有 360 名患者参加了 423 次同步远程过敏就诊，其中 275 次（65.0%）为新诊，54%为男性，118 次（28%）为儿童就诊。过敏性鼻炎（35%）、哮喘（24%）和食物过敏（10%）是前 3 种诊断。新诊和随诊远程过敏就诊分别占研究期间所有门诊就诊的 13.1%（275/2097）和 10.4%（148/1426）。65 名新患者（23.4%）和 14 名随诊患者（9.5%）被推荐进行面对面就诊（P<0.001）。与随诊远程过敏就诊相比，新诊更有可能开具药物（64.4%比 49.0%；P<0.002）和进行实验室检查（46.2%比 7.4%；P<0.001）；新诊和随诊远程过敏就诊的平均研究观察期无差异（P=0.680），根据医生建议进行的后续面对面就诊（P=0.120）或电话咨询（P=0.190）也无差异。有 140 名（33.1%）患者完成了匿名满意度调查，其中 98.8%的患者推荐远程医疗，并表示高度满意。根据 13 个就诊地点的 423 次就诊，患者每次就诊平均节省 485 美元的交通费、438 英里的车程和 2.3 天的工作或上学时间。
远程过敏就诊在很大程度上支持了新诊和随诊就诊，而无需推荐面对面就诊，同时患者满意度高，且能显著节省时间和费用。尽管并非所有远程过敏治疗都采用了具有专门患者代表的同步模式，但过敏专家应继续寻求机会，将具有培训患者代表的同步远程过敏治疗纳入其临床实践。
