DISCUSSION
The COVID-19 pandemic transformed the role of telemedicine in delivering
care to children with pulmonary disorders. Our survey data demonstrate a
high level of satisfaction with telemedicine among clinicians, allied
health professionals and patients’ families. While other publications
exist describing telemedicine experiences during the COVID-19 era in
several other pediatric subspecialties4-8, to our
knowledge, this is the first study examining the use of telemedicine
visits across the full spectrum of conditions treated by pediatric
pulmonary and sleep medicine specialists at a large tertiary care
center.
This study adds important perspectives regarding the feasibility,
acceptability and overall favorability of telemedicine in a field where
physical examination has traditionally played an important role in
evaluation and management. While digital auscultative capabilities
exist, cost and lack of accessibility for many families has constrained
its implementation. Despite these limitations, our study demonstrates
that telemedicine is a feasible and favorable method of healthcare
delivery of pulmonary medicine during the current global health crisis
and beyond.
As defined by the Institute of Medicine, patient-centered care involves
“providing care that is respectful of and responsive to individual
patient preferences, needs and values” and “focuses on the patient’s
experience of illness and healthcare and on the systems that work or
fail to work to meet individual patients’ needs9.”
The patient’s experiences, perspectives and satisfaction are critical
components of patient-centered care, and this study assesses these
important aspects of telemedicine. The results indicate overwhelmingly
positive patient experiences and satisfaction. In healthcare’s ongoing
pursuit of providing quality patient-centered care, these will be
important markers to continue to monitor to ensure we continue to meet
the needs of our patients and their families.
There are several limitations to our data. First, the patient and
provider surveys were not administered in an identical fashion. While
patients were surveyed in association with a single completed
telemedicine visit, providers were surveyed for their overall
telemedicine experiences and attitudes from their cumulative encounters
with telemedicine since the switch to telemedicine with the COVID-19
pandemic. Second, the patient surveys were only sent to those who
completed a telemedicine visit, which could subject our results to bias
due to failure to capture data from those who were unable to complete
telemedicine visits due to difficulties with technology and/or those who
lacked the appropriate resources needed to complete a telemedicine visit
(e.g. no smartphones or reliable internet services). Third, the patient
surveys were not sent immediately at the conclusion of the visit
encounter. While this presents a potential for patients and families to
forget some of the details regarding their visit, none of our survey
questions relied on recalling specific details of the visit, making it
less likely that their responses would differ significantly with this
short lapse in time. Fourth, only 6.9% of patients who were sent a
survey responded, thus there is the possibility that our results could
be different than if we had received responses from all patients.
Finally, our data queried patients and providers for subjective
experiences and did not include objective metrics. However, a large
component of the patient-centered healthcare model is about the patient
experience, so the insights gained from our study offer invaluable
information. Future studies are needed to examine the impact of
telemedicine on objectively measurable health outcomes.