The widespread adoption of telehealth during the COVID-19 pandemic has improved access to specialty care for people with hemophilia, made it more convenient, and increased patient engagement, a study based on surveys reported.
Healthcare providers at an Irish care center also expressed overall satisfaction with telemedicine’s use, and an interest in continuing to offer it after public health restrictions are lifted.
The study, “Telehealth for delivery of haemophilia comprehensive care during the COVID‐19 pandemic,” was published in the journal Haemophilia.
Telehealth, or telemedicine, uses technology such as telephones and computers to deliver care to patients without requiring them to come to a center. Even before COVID-19 restrictions were in place, telehealth held promise as a way to provide more care options to people with hemophilia. It also allows patients to access care from their home or office, and to be treated in a more timely manner.
In Ireland, electronic health records and online management of hemophilia treatments have made broader telemedicine use more feasible in recent years.
Investigators at the National Coagulation Centre, St James’s Hospital, a European Haemophilia Comprehensive Care Centre in Dublin, used surveys to evaluate patient and health provider experiences with telehealth during the pandemic.
Patient surveys were given after phone or video consultations between March 11 and April 30, and after virtual physiotherapy services for people with severe hemophilia. Providers were also surveyed.
Results showed a 63% decrease in in-person visits in March, when COVID-19 restrictions became active across Ireland, compared with visits made in March 2019 (94 vs. 252). The center began using telehealth in mid-March, and consultations rose in April to 230, while remaining below the 305 recorded in April 2019. By May, when the telehealth system was fully integrated, consultations had increased by 52% from the previous year, rising to 401 consultations from to 268 in May 2019.
A total of 731 patients had medical consultations during the study period (March to May), including 130 new patients. Their median age was 44, 54% were female and 46% were male. Nearly half lived outside of Dublin, some more than three hours from the care center.
Notably, the center reported a 60% reduction in non-attendance rates for medical appointments with telehealth, from 15% in March–May 2019 to 6% over the same period this year.
Surveys were sent to 100 telemedicine patients, and 36% responded: 29 who had telephone consultations, and 7 with video consultations. Most felt that teleconsultations improved access (79%) and convenience (82%), and allowed for good communication with their healthcare providers (97%). The main limitations of telemedicine were a lack of accommodations for visual impairments, language barriers, and poor internet access, patients reported.
Physical therapy for severe hemophilia also saw consultations drop by 22% in March (31 visits) compared with that month in 2019 (42 visits). However, appointments by May had increased to levels 35% higher than before the pandemic, with 66 consultations by May compared with 49 in 2019. Most March–May physiotherapy sessions were done by telephone (46%) or video (27%), with another 27% face‐to‐face.
A large majority, 94%, of these patients reported being satisfied or very satisfied with their telehealth physical therapy, while 40% were interested in a remote annual physical therapy assessment, and 63% in a remote exercise class by video or via an app.
Acute dental issues over six weeks led to 89 telephone or video dental consultations. Ten of 22 necessary tooth extractions (abscesses or severe toothache) took place at the hospital’s clinic, while 12 were done at local dental clinics.
“Telementoring for patients and their dentist, to assure their confidence and competence, was a key feature to ensure safe outcomes,” the study reported, noting that no bleeding issues were reported with any of the dental care given.
An online survey was administered to 25 healthcare providers, including nine nurses, eight physicians, three allied health professionals, and one dentist. Response rate was 84%.
Most providers felt positive about telehealth, with the majority expressing confidence in conducting telephone (90%) and video (86%) consultations, and stating they would continue teleconsultation as a part of routine patient care.
Importantly, 90% of providers said that the inability to perform phlebotomy during a teleconsultation was not a major barrier for providing care to people with hemophilia. Rather, they saw its main limitations to concern technical issues and a lack of technology access and training.
“Collectively, our data suggest that telehealth may not replace traditional physician-patient interactions in all circumstances, but has the potential to augment face-to-face model of care,” the researchers wrote.
Suggestions for improvement included better telehealth education and training to enhance patient experience, and providing the option for in-person visits.
“The implementation of telehealth in the COVID-19 pandemic,” the researchers concluded, has “heralded a new service delivery paradigm — the personalization of delivery of haemophilia comprehensive care through a blended model of face-to-face and TM [telemedicine].
“This hybrid model enables individualized care which is flexible and adaptable and recognizes the variability of personal circumstances,” they added.
Among study limitations were a limited response rate to patient surveys, as well as the possible influence of the current pandemic and related public health concerns on answers given, the investigators said.
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