In-office Visits Research Articles

Bridging the Digital Divide in Teledermatology Usage: A Retrospective Review of Patient Visits.

We sought to analyze the demographics of patients utilizing synchronous video visits (SVs), asynchronous visits (AVs), and in-office visits (IVs) following the implementation of SVs. We conducted a retrospective review of medical records and gathered patient demographics from 17,130 initial dermatology visits between July and December 2020. Diagnosis, age, sex, race, ethnicity, and insurance type were compared across visit types. We concluded that the implementation of SVs may increase access to dermatologic care among medically marginalized patients. Patient engagement and education as well as advocacy for continued Medicaid payment parity regulations for SVs are needed to increase dermatologic care access.

Pediatric otolaryngology trends in patient care volume during covid-19: A survey study

PurposeTo assess changes in outpatient clinic, inpatient consult, and operative volumes among pediatric otolaryngologists in response to the COVID-19 pandemic. Materials and methodsAn online questionnaire was distributed to 535 active members of the American Society of Pediatric Otolaryngology from April 21, 2020, to May 4, 2020. The questionnaire assessed operative and clinical volumes during a two-week period between April 6, 2020, to April 20, 2020, while restrictions on elective surgery were in place, as compared to an average two-week period before the start of the COVID-19 pandemic. ResultsBoth outpatient clinic and inpatient consult visit volume decreased significantly during the Covid-19 period. Academic practitioners typically reported seeing fewer outpatient visits than their private practice counterparts. Operative case volume decreased significantly across all procedures and surgeries common to pediatric otolaryngology. One-third of surveyed surgeons reported no operative cases during the assessed period. ConclusionsPediatric otolaryngologists reported a severe reduction in operative volume, in-office visits, and inpatient consults during a time period at the peak of the 2020 Covid-19 outbreak. Many respondents saw no patients, nor operated in any capacity. This time period could have lasting effects on practitioner finances and trainee education.

The Feasibility, Effectiveness and Acceptance of Virtual Visits as Compared to In-Person Visits among Clinical Electrophysiology Patients during the COVID-19 Pandemic.

The feasibility and effectiveness of virtual visits (VVs) for cardiac electrophysiology patients are still unknown. We aimed to assess the feasibility and effectiveness of VVs as compared to in-person visits, and to describe patient experience with virtual care in clinical electrophysiology. We prospectively enrolled patients scheduled to receive a clinical electrophysiology evaluation, dividing them in two groups: a VV group and an in-person visit group. Outcomes of interest were: (1) improvement in symptoms after the index visit, (2) disappearance of remote monitoring (RM) alerts at follow-up, (3) necessity of urgent hospitalization and (4) patient satisfaction measured by the Patient Satisfaction Questionnaire-18 (PSQ-18). This study included 162 patients in the VV group and 185 in the in-office visit group. As compared to in-person visits, VVs resulted in a similar reduction in RM alerts (51.5% vs. 43.2%, p-value 0.527) and in symptomatic patient rates (73.6% vs. 56.9%, p-value 0.073) at follow-up, without differences in urgent hospitalization rates (p-value 0.849). Patient satisfaction with VVs was higher than with in-person evaluation (p-value < 0.012). VVs proved to be as feasible and as effective as in-person visits, with high patient satisfaction. A hybrid model of care including VVs and in-person visits may become the new standard of care after the COVID-19 pandemic is over.

Predictors of patients' acceptance of video consultation in general practice during the coronavirus disease 2019 pandemic applying the unified theory of acceptance and use of technology model.

The coronavirus disease 2019 pandemic has led to an increase in remote consultations in health care. This study aimed to assess the acceptance of video consultation as an alternative to face-to-face in-office visits in general practice (GP) and to investigate its drivers and barriers. A cross-sectional study was conducted in Germany during the coronavirus disease 2019 pandemic from December 2020 to April 2021. Participants were recruited among patients in 16 GP surgeries. Assessed were sociodemographic and medical data as well as information and communications technology related data. Acceptance of video consultation and its predictors were determined using a modified questionnaire based on a short version of the renowned unified theory of acceptance and use of technology model. In total, 371 participants were included in the data analysis. Acceptance of video consultation was moderate. A hierarchical regression revealed acceptance was significantly predicted by the PHQ-2, taking no regular medication, computer proficiency, knowledge about digital health care solutions, no prior use of video consultation, and the unified theory of acceptance and use of technology predictors performance expectancy, effort expectancy, and social influence. The extended unified theory of acceptance and use of technology model explained significantly more variance than the restricted unified theory of acceptance and use of technology model in acceptance of video consultation. In this study computer proficiency, existing knowledge about digital health care solutions and depressive symptoms functioned as drivers to acceptance, no prior use of video consultation could be identified as a potential barrier. Patients with regular medication have been particularly receptive to video consultation. The study confirmed the validity of the unified theory of acceptance and use of technology model in determining acceptance of video consultation. Considering that there is growing demand and acceptance for different approaches to engage with health care providers, additional steps should be taken to establish video consultation as a genuine alternative.

The Use of Telemedicine to Improve Hypertension in an Urban Primary Care Clinic and Predictors of Improved Blood Pressure.

Meta-analysis of randomized controlled trials have demonstrated the efficacy of telemedicine in blood pressure (BP) management when compared to conventional care. We initiated a hypertension telehealth clinic in our urban primary care clinic and through this study aim to evaluate the strengths and limitations of telemedicine in hypertension (HTN) control. The primary outcome of the study is to identify the proportion of patients with improved HTN. Secondary outcomes included identifying: predictors for lower BP, predictors of missing telehealth appointments, and comorbid conditions that are more likely to necessitate use of more than 1 antihypertensive medication. Patients seen in the HTN telehealth clinic from May 1st, 2022 to October 31st, 2022 were identified. A retrospective chart review was done to compare the BP during in-person visit prior to first telehealth visit, telehealth visit home BP readings and last recorded in-office BP on chart at end of study period. Descriptive statistical analysis, Chi Square test, and multivariable logistic regression was used to analyze data. Of the 234 appointments, 83% were conducted and 154 patients were seen. A remarkable decrease in percentage of patients with BP >140/90 was seen when comparing in-office visit BP to first telehealth visit home BP, 72% versus 45% respectively. No remarkable difference was noted in percentage of patients with BP >140/90 when comparing first telehealth visit home BP to last in-office BP recorded on chart, 45% and 41% respectively. Patients with diabetes had lower odds of missing appointments, adjusted odds ratio (aOR): 0.34 ([0.12-0.91], P = .03). Patients with partners were more likely to have lower BP at the telehealth visit, aOR:3.2 ([1.15-9.86], P = .03) while patients with obstructive sleep apnea (OSA) (aOR 0.27 ([0.08-0.77], P = .02) and CAD, aOR 0.24 ([0.06-0.8], P = .03) were less likely to have lower BP. The study demonstrated telemedicine as a great tool to prevent overtreatment of hypertension as significant difference between in-office BP and home BP during telehealth visits was noted. We did not see a significant change in blood pressure when comparing home BP at first telehealth visit to the last in-person clinic BP at end of study period.

Artificial intelligence driven dental monitoring and surveillance of malocclusion treatment in orthodontic patients

Background: Orthodontic treatment success does not only depend on proper diagnosis and treatment, but also on patient’s compliance. Patient’s progress and compliance can be monitored through in-office visits at certain time intervals. However, this interval is not necessarily ideal for every patient. Purpose: To overcome this limitation, Dental Monitoring® (DM) is introduced as artificial intelligence (AI) driven remote monitoring, which analyzes tooth movement, oral hygiene, and the condition of orthodontic appliances. This study aimed to describe the clinical application of DM based on the number of in-office visits, duration of treatment, number of refinements, stability of retention phase, tooth movement, patient's oral hygiene, and patient’s subjective perception regarding DM. Review: Based on five articles included, the use of DM during orthodontic treatment had several advantages including the increase of patient’s compliance on maintaining oral hygiene and significant reduction of in-office visits, thus increasing the treatment’s effectiveness and comfort for patients. Duration of treatment and number of refinements that do not differ significantly between DM and non-DM users are considered as DM’s other advantages as it could reduce in-office visits without compromising treatment’s effectiveness. Orthodontic relapse can also be identified hence severe relapse can be prevented. Conclusion: The clinical application of DM can reduce in-office visits, improve oral hygiene and retention stability. However, the use of DM must be carefully considered to prevent decline in doctor-patient relationships

Exploring Patient Perspectives Surrounding Telemedicine Versus In-Person Preoperative Visits.

Telemedicine was increasingly used to provide patients with an alternative to in-office visits during the COVID-19 pandemic. While previous studies have described the role of telemedicine for preoperative visits for other surgical specialties, the role of this modality in preoperative visits for gynecologic surgery has not been thoroughly explored. The aims of the study are to explore and compare patient experience, decision making, and satisfaction among women undergoing telemedicine or in-person preoperative visits. This was a qualitative study of women who underwent a preoperative appointment with a urogynecologic surgeon or minimally invasive gynecologic surgeon at a single academic institution from April to May of 2021. Data were collected using semistructured phone interviews, which focused on visit content, visit type decision making, surgical preparedness/confidence, and past surgical experiences. Interviews were thematically analyzed until theoretical saturation was achieved in accordance with grounded theory. Theoretical saturation occurred with 20 interviews. Participants were evenly divided between in-person and telemedicine visits. Major themes included visit content, experience/quality, surgeon perception, and surgical preparedness. Advantages of telemedicine visits were convenience and safety. Advantages of in-person visits were social factors, perceived medical or surgical severity, and preoperative physical examination. Disadvantages for telemedicine visits included technology concerns and difficulty accessing preoperative materials. The disadvantage of an in-person visit was the inability to have family present because of COVID hospital policy restrictions. Participants in both groups felt prepared for surgery and reported high satisfaction with their care. Decision making for selecting an in-person or telemedicine visit is complex and involves balancing multiple advantages and disadvantages. Participant experience was similar for both visit types with high satisfaction.

Patient Satisfaction With Medical and Social Concerns Addressed During Telemedicine Visits.

Purpose The use of telemedicine dramatically increased during the COVID-19 pandemic.Assessing patient satisfaction with this mode of healthcare delivery is an important metric of success as it is broadly implemented across various settings. Of additional importance are the ways social determinants of health impact health outcomes, with the first step in determining the scale of this impact being the identification of contributing factors. This study assesses patient satisfaction with the medical and social aspects of the care they receive via telemedicine at a university-affiliatedprimary care training clinic in Detroit, Michigan. Methods A survey was designed to assess patient satisfaction with the technical aspects of the visit, the visit itself, and with the social determinants screening tool used. During July 2020, 167 patients who had at least one telemedicine visit with a primary care physician from the clinic in the preceding months were contacted to assess their impression of the service provided. The responses were used to evaluate patient satisfaction with the comprehensive care provided via the telemedicine visit. Results Of the 167 patients contacted, 79 (47%) completed the survey. Respondents' age ranged from 18-74 years, with 66% identifying as femaleand 34% as male. For many, this was their first experience with telemedicine. The vast majority expressed comfort in sharing details about their health concerns via telemedicine, with only 3% reporting they were "uncomfortable." More than half of the patients (60%) felt some level of comfort with telemedicine after their first encounter; 14% stated that they were still uncomfortable, and 26% were neutral. Most of the patients (88%) asserted their willingness to participate in future telemedicine visits. Just under two-thirds (63%) of participants "strongly agreed" that concerns related to their social determinants of health were addressed, and 59% "strongly agreed" that the resources provided by their physician were helpful. Conclusion This survey evaluates multiple dimensions of patient satisfaction with their physician using technology to deliver a telemedicine visit instead of an in-office visit. Telemedicine was well received, with high satisfaction for addressing medical and social concerns. The results of this study support the use of telemedicine to assess social determinants of health in an underserved minoritized patient populationand will help physicians optimize future interactions with patients through telemedicine.

Telemedicine Satisfaction and Preferences in an Orthopaedic Spine Clinic.

The use of telemedicine has expanded amid the COVID-19 pandemic and office closures and cancellation of elective surgeries early in the pandemic helped propagated its use. Previous studies have described the feasibility of telemedicine, however, little has been reported on patient perception and preferences within orthopaedics. The objective of this study was to evaluate satisfaction and preferences of telemedicine from the perspective of patients within an orthopaedic spine clinic. A cross-sectional, anonymous survey was implemented as a prospective quality improvement initiative. The survey was sent to patients who had an in-office or telemedicine visit with a provider in our orthopaedic spine clinic. Statistical analysis was performed on the results of the survey. The survey was sent to 1129 patients and a total of 316 patients responded. Twenty-one percent of respondents had a telemedicine appointment. There was no difference in satisfaction among groups (P = .288) and those with telemedicine appointments were more likely to have had a previous experience with this type of visit (P = .004) and were more inclined to use it in the future (P < .001). Patients preferred telemedicine because of the ability to get earlier appointments (P < .001) and the convenience of the visits (P < .001). Patients preferred in-office visits because they received hands-on physical exams (P = .003) or imaging (P = .041). Telemedicine is a viable alternative to in-office appointments for spine patients, as evidenced by similar levels of patient satisfaction. Sooner appointments and convenience are attractive elements of telemedicine visits, while the desire for physical examination remains a barrier to adoption in this population.

Assessing the Efficacy of Telemedicine in High-Risk Populations by Evaluating Emergency Department Visits and Hospitalizations

Introduction Advances in telemedicine have allowed physicians to provide quality care to high-risk patients with multiple comorbidities who would otherwise be unable to attend an in-person visit. Barriers to the routine use of telemedicine include access to the appropriate devices and understanding how to use applications or software. We hypothesize that patients who were contacted and seen via telemedicine did not have more emergency department visits or hospitalizations compared with patients who had office visits. Methods We conducted an observational quality improvement study with retrospective administrative data collection and analysis. This study took place in an inner-city internal medicine residency primary care clinic. The patient population was defined as those patients 65 years and older with predetermined chronic medical conditions or patients younger than 65 years with chronic health conditions who had not yet had an office, telephone, or video visit within 6 months of March 23, 2020. Results A total of 1340 high-risk individuals were considered for analysis. There were a total of 441 emergency department visits and 254 inpatient hospital admissions within this group. We did not detect a statistically significant difference between emergency department visits or inpatient hospital admissions between telephone, video, or office visits. Conclusions Providing patients with an alternative to an in-office visit may prevent exposures to high-risk patients during the pandemic and provide alternative healthcare access to patients who may struggle with attending their primary care in-office visits.

Developing a Cancer-Associated Thrombosis Clinic: Two-Year Experience

Background: Cancer-associated thrombosis (CAT) is a common comorbidity in patients with cancer. Prior trials have demonstrated that direct oral anticoagulants (DOACs) and low-molecular weight heparins (LMWHs) are safe and effective for CAT management. Despite these data, treatment of CAT is complicated by consequences of both cancers and cancer-directed therapies that can impact anticoagulation options. Methods: We developed the Northwestern Medicine CAT clinic in April 2020 to improve care by streamlining referrals for evaluation and management of CAT by a non-malignant hematologist. Patients were referred for either acute management of new VTE or for ongoing management of previously known VTE. Goal time-to-appointment for acute referrals was within 24 hours and for ongoing management within two weeks. Initial evaluations were completed by advanced practice providers with review by an attending classical hematologist and clinical pharmacist. We manually reviewed electronic health records of patients seen in the CAT clinic since its inception. Data collected included demographic, cancer diagnosis and cancer-directed therapy, CAT clinic recommendations, and recurrent VTE, bleeding and death within 6 months of initial CAT clinic appointment. We used descriptive statistics to assess referral and treatment patterns. Results: One hundred twenty-two patients (N=122) were seen by CAT clinic clinicians between April 2020 - April 2022, including 63 (51%) in the first year. Patients had a median age of 63 years and 56.4% were female. Appointments occurred in nearly equal proportion via telehealth (50.8%) and in-office visits (49.2%) during these two years; however, 78% of visits were telehealth during the first year, and only 25.4% during the second. Forty-three (35.2%) referred for acute management were seen at a median time of two days, and the remainder for ongoing management were seen at a median time of 10 days. Referrals were predominantly for PE (25.4%), concurrent PE/DVT (23.0%), and proximal lower extremity DVT (18.9%); however, consults included thrombi of the cerebral, pulmonary, and splanchnic veins, as well as tumor thrombi, arterial thrombi, and need for primary prophylaxis. Tumor types were categorized into nine groups, with the largest proportion consisting of gastrointestinal (25.4%), gynecologic (17.2%), and hematologic (17.2%) malignancies (Figure 1). DOACs were recommended in 47.5%, and LMWHs in 41% (Figure 2), with a similar proportion of DOACs prescribed between year one (47.5%) and year two (47.6%). Primary reasons for choosing LMWHs over DOACs were perceived bleeding risk (40%), tumor type (22%), and prior DOAC failure (20%). Twelve (9.8%) patients were advised to stop anticoagulation, due to lack of indication for 11 (91.7%) and perceived bleeding risk for one (8.3%). Four were referred for inferior vena cava (IVC) filter retrieval. At the time of evaluation, 16 (13.1%) patients were noted to have platelet counts <150,000/µL, but none had platelet counts <50,000/µL. Within 6 months of initial evaluation, 11 (9.0%) patients developed progressive or recurrent VTE. Fourteen (11.5%) patients experienced bleeding: eight (57.1%) had major bleeding episodes as defined by the International Society on Thrombosis and Hemostasis, and six (42.9%) had clinically-relevant non-major bleeding. Among major bleeding events, six (75%) were gastrointestinal and two (25%) intraabdominal in origin, with no identified intracranial hemorrhages. Twenty (16.4%) died during the follow up period. Seventy-six (61.8%) patients were seen for a follow up visit after initial consultation. Conclusion: Building the CAT clinic led to improved access to classical hematologists with thrombosis expertise to manage CAT. Historical wait times for this specialty have exceeded 90 days, while those referred to the CAT clinic had a median time-to-appointment of only nine days. Highlighting the complexity of CAT management, more than 40% of patients were not treated with DOAC, primarily related to perceived bleeding risk. Four patients were identified for IVC filter removal, suggesting there may be additional benefits to non-malignant hematologists beyond anticoagulant management. Decisions regarding treatment of individual patients with CAT remain complex, and access to thrombosis specialists provides additional expertise to optimize care. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Usage of RePlay as a Take-Home System to Support High-Repetition Motor Rehabilitation After Neurological Injury.

Stroke is a leading cause of chronic motor disability. While physical rehabilitation can promote functional recovery, several barriers prevent patients from receiving optimal rehabilitative care. Easy access to at-home rehabilitative tools could increase patients' ability to participate in rehabilitative exercises, which may lead to improved outcomes. Toward achieving this goal, we developed RePlay: a novel system that facilitates unsupervised rehabilitative exercises at home. RePlay leverages available consumer technology to provide a simple tool that allows users to perform common rehabilitative exercises in a gameplay environment. RePlay collects quantitative time series force and movement data from handheld devices, which provide therapists the ability to quantify gains and individualize rehabilitative regimens. RePlay was developed in C# using Visual Studio. In this feasibility study, we assessed whether participants with neurological injury are capable of using the RePlay system in both a supervised in-office setting and an unsupervised at-home setting, and we assessed their adherence to the unsupervised at-home rehabilitation assignment. All participants were assigned a set of 18 games and exercises to play each day. Participants produced on average 698 ± 36 discrete movements during the initial 1 hour in-office visit. A subset of participants who used the system at home produced 1593 ± 197 discrete movements per day. Participants demonstrated a high degree of engagement while using the system at home, typically completing nearly double the number of assigned exercises per day. These findings indicate that the open-source RePlay system may be a feasible tool to facilitate access to rehabilitative exercises and potentially improve overall patient outcomes.

The Impact of Telehealth on Primary Care Physician Panel Sizes: A Modeling Study.

Most research on the use of telehealth in lieu of in-office visits has focused on its growth, its impact on access, and the experience of physicians and patients. One important issue that has not gotten much attention is the potential for telehealth to significantly increase physician capacity by reducing nonvalue adding activities and patient no-shows. We explore this in this article. We use data from the electronic health records of 2 health care systems and information gathered from family medicine physician focus groups to develop estimates of visit durations and no-show rates for tele-visits. We use these in a simulation model to determine how patient panel sizes could be increased while maintaining high levels of access by substituting tele-visits for in-person visits. We found that tele-visits reduce the nonvalue-added time physicians spend with patients as well as patient no-shows. At current levels of tele-visit utilization, the use of tele-visits may translate into more than a 10% increase in patient panel sizes assuming a modest reduction in visit durations and no-shows, and as much as a 30% increase assuming that half of all visits could be effectively conducted virtually and result in a greater reduction in visit durations and no-shows. Our study provides evidence that a major benefit of using telehealth for many routine encounters is a reduction in wasted physician time and a substantial increase in the number of patients that a primary care physician can care for without jeopardizing access to care.

Remote versus in-office monitoring for implantable cardioverter defibrillators: Results from a randomized pragmatic controlled study in Portugal

IntroductionRemote monitoring (RM) is a safe and effective alternative to in-office conventional follow-up. ObjectiveWe aimed to evaluate patient satisfaction with RM and its impact on healthcare resources in a population with cardiac implantable electronic devices. MethodsRandomized, pragmatic, open-label controlled trial, with adult wearers of implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy with ICD (CRT-D), eligible for the CareLink® system. Patients newly implanted or with previous conventional follow-up were randomized to RM or conventional follow-up (control), and followed for 12 months, according to the centers’ practice. The number of in-office visits and adverse events were compared between groups. Patient and healthcare professionals’ satisfaction with RM were described. ResultsOf the 134 randomized patients (69 RM; 65 control, aged 60±13 years), 80% were male, 23% employed, 72% ICD wearers and 54% newly implanted. Most patients (70%) reported travel costs less than 15€/visit, and 46% daily routine interference with in-office visits. Median physician/technician time with patient was 15 min/15 min, per in-office visit. Excluding baseline and final visits, control patients had more in-office visits in total: median 1 vs. 0, p<0.001. In 81% of the in-office visits, no clinical measures were taken. There were 10 adverse events, with no differences between groups. At the final visit, 95% of RM patients considered RM easy/very easy to use, and would all prefer to maintain RM and recommend it to others. All professionals found the CareLink website easy/very easy to use and were satisfied with transmission data. ConclusionsIn a Portuguese population with ICD and CRT-D, RM safely reduced the burden of in-office visits, with high levels of satisfaction among patients and healthcare professionals.

Use of Telemedicine in an OBGYN Residency Clinic During COVID

INTRODUCTION:Telemedicine can address healthcare disparities by improving access to care and eliminating barriers to in-office appointments. The primary goal of this study is to compare the number of completed telemedicine appointments to the number of completed in-office appointments for an OBGYN residency clinic during the early months of the COVID pandemic. The study also aims to evaluate patient demographics and types of visits performed using telemedicine. METHODS: All OBGYN residency clinic visits at a single institution from March 2020 – May 2020 were included and reviewed. Proportions of the visit type were evaluated for completion as well as the inability to complete the appointment through the telemedicine format. Information collected for the telemedicine visits includes the patient age, primary language spoken, and use of an interpreter during the visit. For patients who were a “no show” to a telemedicine appointment, appointments were reviewed to assess if the patient rescheduled or was lost to follow up. Overall appointment completion rates were compared between telemedicine and in-office visits using a Chi-squared test. RESULTS: Between March - May 2020, there were 598 telemedicine visits at the residency clinic, with 479 (80.1%) completed and 119 (19.9%) not completed. By comparison, in-office visits totaled 3,158 visits, with 78% (2,473) completed and 22% (685) not completed. Chi-squared test comparing telemedicine versus in office visits resulted in a non-significant p-value of 0.32. CONCLUSION:The overall visit completion rate between telemedicine and in-office visits from March - May 2020 was similar. The p-value comparing the completion rates was nonsignificant at 0.32, suggesting the telemedicine visit completion rate is comparable to in-office appointment completion rate.

Telehealth for the Management of Diabetes in Pregnancy.

Purpose of ReviewTelehealth initiatives are becoming ubiquitous in clinical practice and can be a useful tool in the management of diabetes in pregnancy. The purpose of this review is to summarize new techniques in telemedicine delivery and offer details on how to leverage telehealth in delivering care to pregnant women with diabetes.Recent FindingsUsing mobile phone technology to collect glucose values in women with gestational diabetes has been found to be beneficial by increasing the amount of glucose data available for interpretation. Remote patient monitoring in non-pregnant people with type 2 diabetes has shown a modest improvement in glucose control. In pregnant women with diabetes, the use of remote patient monitoring does not appear to improve outcomes but can decrease in-office visits and lower healthcare costs. However, telehealth may not be the only solution to helping patients with diabetes in pregnancy who have difficulty engaging in their care.SummaryTelehealth affords improvements in convenience, efficiency, and frequency of communication with healthcare professionals, and the amount of data available to patients and providers alike, yielding the potential for better outcomes when telehealth modalities are adopted.

Three-question Skindex-Mini measures quality of life in children with atopic dermatitis

To the Editor: Skin disorders are often highly visible, pruritic, and painful, leading to considerable burden. Patient-reported symptoms and impacts of skin disease are important in determining well-being but are often missed in physician assessments and do not correlate well with visible signs of disease.1 The Skindex-29, Skindex-16, and Skindex-Teen are validated instruments that measure patients’ perceptions of the impact of skin disease on quality of life.1 The Skindex-Mini, a 3-item questionnaire assessing 3 domains (symptoms, emotions, and function), was created to retain the validity and reliability of its Skindex predecessors while prioritizing ease of use at in-office visits.

An Unanticipated Worsening of Glycemic Control Following a Mild COVID-19 Infection

We describe a case of acute-onset worsening of a patient’s previously well-controlled type 2 diabetes mellitus (T2DM) following his recovery from a novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. A 78-year-old male with a three-year medical history of well-controlled T2DM (controlled by diet and metformin) presented to the outpatient clinic to discuss his regularly scheduled six-month lab work. He mentioned having a mild coronavirus disease 2019 (COVID-19) infection lasting one week which required no medical treatment approximately two months before his current visit. His labs, taken one week prior to his current visit, were notable for fasting hyperglycemia, 301mg/dL, and an elevated hemoglobin A1C (HbA1C), 11%. A fasting blood glucose level was recorded at his current in-office visit and was found to be 403mg/dL. These findings were not anticipated - our patient reported no change in his meals, medications, or exercise routines. The only notable change he reported between visits was his COVID-19 infection. This case report explores the link between this virus and our patient's exacerbation of his previously well-controlled T2DM. Whether it be through insulin resistance or deficiency (or another unknown mechanism), our patient's prior novel COVID-19 infection could potentially be associated with his unprecedented altered glucose metabolism.

Utility of Teleorthodontics in Orthodontic Emergencies during the COVID-19 Pandemic: A Systematic Review

Background. Coronavirus disease has subjected the whole of humanity to two years of social isolation and a series of restrictions. These circumstances have led to the use of information technology in an increasingly widespread manner. Even in the dental field, telematic means have been used to respond to emergencies. The aim of this systematic review of the literature is to evaluate the types of orthodontic emergency that occurred most often and how they were managed by teleorthodontics during the COVID-19 pandemic. The secondary aim is that clinicians will use teleorthodontics not only during pandemics but as an additional tool to manage orthodontics. Materials and Methods. Out of 1695 articles available on PubMed, Science Direct, Cochrane and SciELO, eight articles were selected for this systematic literature review. Google Scholar was used as a secondary source to confirm that there were no additional articles. The screened papers comprised editorials, clinical studies, cross-sectional studies and retrospective studies in Italian, English or Spanish language. Results. The articles showed that the means by which patients most often communicated with their orthodontists were voice calls and smartphone applications such as WhatsApp® Messenger. Through these media, patients communicated their orthodontic emergencies. These mainly involved fixed multibracket appliances and the most common issues were discomfort and pain, fracture or loss of the appliance, protruding distal ends of archwires, brackets, tubes and bands or retainer detachment. Through teleorthodontics, patients could solve these issues by using orthodontic relief wax, cutting the protruding distal ends of the archwire with a nail clipper or a stronger cutter and removing or replacing detached bands, brackets, tubes or metallic ligature with a clean tweezer. Conclusions. In situations where personal contact is limited, teleorthodontics represents a valuable aid for professionals and patients facing orthodontic emergencies. The hope is that it may continue to represent a valuable aid for patients with difficulties in planning an in-office visit.

1261-P: Is Glycemic Control Better in Adults with Type 1 Diabetes When Office Visits are Supplemented with Telehealth Visits?

Objective: Since the COVID-pandemic began, instead of in-office care alone, many institutions implemented hybrid care (in-office + telemedicine) . It is not known if hybrid care is as effective as in-office visits in regards to achieving glycemic goals. Methods: Clinical characteristics of adults with type 1 diabetes (T1D) (age ≥40 years) were retrieved from electronic health records from two periods: in-office model before the pandemic (April 2019-March 2020) and hybrid-care model during the pandemic (September 20pril 2021) . Patients were stratified by age. Results: Overall, 1,820 patients were evaluated, 66% younger (40-64 years: mean age 52±7yrs, 52% female, 53% CGM users, 56% pump users) and 34% older (≥65 years: mean age 72±5yrs, 55% female, 53% CGM users, 38% pump users) . A1c using hybrid-care improved in both younger (7.8±1.2 vs. 7.6±1.2%; p=0.005) and older adults (7.6±0.9 vs. 7.4±1%; p=0.02) , compared to in-office care. Within the hybrid-care model period, poor glycemic control was associated with a higher number of hybrid visits, and more in-office missed appointments, while pump use was associated with lower A1c. Conclusion: Compared with in-office care, hybrid care was effective at maintaining glycemic control in both younger and older adults with T1D. Prospective studies are needed to understand the use of hybrid-care for the management of adults with T1D. Disclosure E.Toschi: Consultant; Medtronic. A.Adam: None. C.Slyne: None. L.M.Laffel: Advisory Panel; Medtronic, Roche Diabetes Care, Consultant; Boehringer Ingelheim International GmbH, Dexcom, Inc., Dompé, Insulet Corporation, Janssen Pharmaceuticals, Inc., Lilly Diabetes, Novo Nordisk, Provention Bio, Inc. M.Munshi: Consultant; Sanofi.