Waiting Time For Appointment Research Articles

Association of eConsult Implementation With Access to Specialist Care in a Large Urban Safety-Net System.

Accessing specialty care continues to be a persistent problem for patients who use safety-net health systems. To address this access barrier, hospital systems have begun to implement electronic referral systems using eConsults, which allow clinicians to submit referral requests to specialty clinics electronically and enable specialty reviewers to resolve referrals, if appropriate, through electronic dialogue without an in-person visit. Measure the effect of implementing an eConsult program on access to specialty care. Using an interrupted time series design with data from 2016 to 2020, this study analyzed 50 260 referral requests submitted during the year before and the year after eConsult implementation at 19 New York City Health + Hospitals (NYC H+H) specialty clinics that spanned 7 NYC H+H hospital facilities and 6 unique specialties. Referral request was submitted to a specialty clinic in the year following eConsult implementation. Main outcomes included the fraction of referral requests resolved without an in-person visit following eConsult implementation; and, among requests triaged to have an in-person visit, the fraction of referrals with a successfully scheduled appointment, mean wait time to a specialty appointment, and the fraction of referral requests with a completed specialty visit. Changes associated with eConsult implementation were estimated using multivariate linear regression adjusting for patient age, gender, and specialty clinic fixed effects. Across 19 NYC H+H specialty clinics, 26 731 referral requests were submitted in the year before and 23 529 referrals were submitted in the year after eConsult implementation. Following eConsult implementation, 13% of all requests were resolved electronically. Among requests requiring a follow-up visit, the fraction with an appointment successfully scheduled increased by 15.8%, from 66.5% to 82.3% (P < .001). The mean time to an appointment decreased from 61.0 days pre-eConsult to 54.1 days post-eConsult, an adjusted 8.2-day shorter wait time (or 13.3% reduction) following eConsult adoption (P < .001). The percentage of referrals with a completed follow-up visit with a specialist within 90 days of the request did not change (38.4% vs 37.9%, P = .07). Changes in outcomes were mitigated during months when most clinics underwent an electronic health record transition after implementing eConsult. In this quality improvement study, implementation of eConsults at a large multi-specialty safety-net system was associated with improvements in appointment scheduling rates and wait times. Despite an additional electronic health record transition, eConsults are a promising health care delivery tool for increasing access to specialty care.

Awareness screening and referral patterns among pediatricians in the United States related to early clinical features of spinal muscular atrophy (SMA)

BackgroundSpinal Muscular Atrophy (SMA), a leading genetic cause of death in infants, is an autosomal recessive neuromuscular disease characterized by progressive muscle weakness and atrophy. While early diagnosis of SMA is critical to modifying disease progression and improving outcomes, serious diagnostic delays persist. There is a need to improve SMA awareness, screening, and referral patterns.MethodsTwo online surveys, developed by Cure SMA for general pediatricians, were distributed by Medscape Education via email (September 2018, n = 300, December 2019, n = 600). The surveys asked about adherence to the American Academy of Pediatrics (AAP) developmental screening and surveillance guidelines, comfort with identification of early signs of neuromuscular disease (NMD), familiarity with SMA, and barriers to timely referral.ResultsIn 2018, 70.3% of survey respondents indicated comfort in identifying early signs of NMD and 67.3% noted familiarity with SMA. 52.7% correctly indicated the need for genetic testing to make a definitive diagnosis of SMA, 74.0% meet or exceed developmental screening recommendations, and 52.0% said they would immediately refer to a specialist. In 2019, with a larger sample, 73.0% adhere to developmental screening guidelines, and awareness of the genetic testing requirement for SMA was significantly lower by 7.7% (p < 0.03). Specialist wait times emerged as a barrier to referral, with 64.2% of respondents citing wait times of 1–6 months.ConclusionsMany pediatricians underutilize developmental screening tools and lack familiarity with diagnostic requirements for SMA. Continuing efforts to expand awareness and remove barriers to timely referral to SMA specialists, including reducing appointment wait times, are needed.

Primary Care Access During the COVID-19 Pandemic: a Simulated Patient Study.

BackgroundPrimary care practices have experienced major strains during the COVID-19 pandemic, such that patients newly seeking care may face potential barriers to timely visits.ObjectiveTo quantify availability and wait times for new patient appointments in primary care and to describe how primary care practices are guiding patients with suspected COVID-19.DesignTrained callers conducted simulated patient calls to 800 randomly sampled primary care practices between September 14, 2020, and September 28, 2020.ParticipantsWe extracted complete primary care physician listings from large commercial insurance networks in four geographically dispersed states between September 10 and 14, 2020 (n=11,521). After excluding non-physician providers and removing duplicate phone numbers, we identified 2705 unique primary care physician practices from which we randomly sampled 200 practices in each region.Main MeasuresPrimary care appointment availability, median wait time in days, and practice guidance to patients suspecting COVID-19 infection.Key ResultsAmong 56% of listed practices that had accurate contact information listed in the directory, 84% offered a new patient in-person or virtual appointment. Median wait time was 10 days (IQR 3–26 days). The most common guidance in case of suspected COVID-19 was clinician consultation, which was offered in 41% of completed calls. Callers were otherwise directed to on-site testing (14%), off-site testing (24%), a COVID-19 hotline (8%), or an urgent care/emergency department (12%), while 2% of practices had no guidance to offer.ConclusionsDespite resource constraints, most reachable primary care practices offered timely new patient appointments as well as direct COVID-19 care. Pandemic mitigation strategies should account for and support the central role of primary care practices in the community-based pandemic response.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-021-06804-7.

Patient experiences with telehealth in sleep medicine: a qualitative evaluation.

The field of sleep medicine has been an avid adopter of telehealth, particularly during the COVID-19 pandemic. The goal of this study was to assess patients' experiences receiving sleep care by telehealth. From June 2019 to May 2020, the authors recruited a sample of patients for semi-structured interviews, including patients who had 1 of 3 types of telehealth encounters in sleep medicine: in-clinic video, home-based video, and telephone. Two analysts coded transcripts using content analysis and identified themes that cut across patients and categories. The authors conducted interviews with 35 patients and identified 5 themes. (1) Improved access to care: Patients appreciated telehealth as providing access to sleep care in a timely and convenient manner. (2) Security and privacy: Patients described how home-based telehealth afforded them greater feelings of safety and security due to avoidance of anxiety-provoking triggers (eg, crowds). Patients also noted a potential loss of privacy with telehealth. (3) Personalization of care: Patients described experiences with telehealth care that either improved or hindered their ability to communicate their needs. (4) Patient empowerment: Patients described how telehealth empowered them to manage their sleep disorders. (5) Unmet needs: Patients recognized specific areas where telehealth did not meet their needs, including the need for tangible services (eg, mask fitting). Patients expressed both positive and negative experiences, highlighting areas where telehealth can be further adapted. As telehealth in sleep medicine continues to evolve, the authors encourage providers to consider these aspects of the patient experience. Donovan LM, Mog AC, Blanchard KN, et al. Patient experiences with telehealth in sleep medicine: a qualitative evaluation. J Clin Sleep Med. 2021;17(8):1645-1651.

Leveraging Telehealth for Delivery of Palliative Care to Remote Communities: A Rapid Review.

Background: Palliative care encompasses supportive health care for patients at any stage of illness aimed at relieving symptoms, controlling pain, managing stress, offering respite for caregivers, and optimizing the quality of life. Objective: To explore strategies for increasing access to palliative care among individuals living in remote/rural communities, a rapid review was conducted on studies that explored the use of telehealth applications with this population. Methods: From December 2019 to February 2020, the PRISMA methodology was used to gather peer-reviewed studies published in the English language. MedLine, Google Scholar, and EBSCO were searched; no date limitations were set. Given the diversity of study methodologies and outcomes, the findings were synthesized narratively. The Cochrane Collaboration's tool for assessing the risk of bias was also employed. Lastly, the studies were mapped to clinical guidelines for the various aspects of quality palliative care. Results: The 18 studies found, published between 2004 and 2019, were conducted in seven countries and on five continents. Aims included evaluating feasibility, efficacy, and user satisfaction. Insights draw from a combined pool of 3,313 patients and 250 providers. Most studies involved oncology patients and employed videoconferencing or a web platform/online software with videoconferencing. Three themes emerged: delivery of care, symptom management and quality of life, and patient/caregiver/provider satisfaction levels. Telehealth proved effective for patient and medication monitoring, provider and specialist appointments, and palliative care consultations. Operational benefits included clinician time saved, shorter appointment wait times, and reduced no show rates; implementation challenges also emerged. Statistical improvements in quality of life and symptom management were reported. Nearly two-thirds of the studies reported positive experiences among patients, caregivers, and providers; about half included an interprofessional team. The studies primarily focused on the structure/process and physical aspects of quality palliative care, there was a paucity of insights on the spiritual, cultural, end of life, and ethical/legal aspects of care. Two-thirds (12/18) of the studies employed a descriptive design. Risk for selection, performance, detection, and reporting biases emerged for all the studies; for example, only four of the studies included control groups and less than 20% (3/18) reported on attrition of study participants. Additional limitations include the rapid review methodology which relied heavily on the lead author's decisions and the restriction of studies published only in the English language. Conclusion: More rigorous research is required to confirm the viability of clinical care delivery and establish best practices for quality, virtual palliative care to remote/rural areas.

Barriers and Facilitators to Genetic Service Delivery Models: Scoping Review.

BackgroundAdvances in diagnostics testing and treatment of genetic conditions have led to increased demand for genetic services in the United States. At the same time, there is a shortage of genetic services professionals. Thus, understanding the models of service delivery currently in use can help increase access and improve outcomes for individuals identified with genetic conditions.ObjectiveThis review aims to provide an overview of barriers and facilitators to genetic service delivery models to inform future service delivery.MethodsWe conducted a scoping literature review of the evidence to more fully understand barriers and facilitators around the provision of genetic services.ResultsThere were a number of challenges identified, including the limited number of genetics specialists, wait time for appointments, delivery of services by nongenetics providers, reimbursement, and licensure. The ways to address these challenges include the use of health information technology such as telehealth, group genetic counseling, provider-to-provider education, partnership models, and training; expanding genetic provider types; and embedding genetic counselors in clinical settings.ConclusionsThe literature review highlighted the need to expand access to genetic services. Ways to expand services include telehealth, technical assistance, and changing staffing models. In addition, using technology to improve knowledge among related professionals can help expand access.

The impact of common variables on non-attendance at a radiology centre in Singapore

IntroductionWith the increasing demand for medical imaging, non-attendance inhibits private and public radiology practices in Singapore from providing timely care and achieving maximal efficiency. Missed radiological appointments adversely affect clinical and economic outcomes and strain the finite healthcare resources. We examined the prevalence and predictors of patient non-attendance for radiological services at a regional public hospital in Singapore and compared them against other medical imaging centres globally. MethodsOutpatient records of patients who were scheduled for specialised medical imaging obtained from Radiological Information System (RIS) were retrospectively reviewed. Analysed variables include patient demographics, radiology modalities, visit statuses and appointment lead times where Pearson's chi-square test and Fisher's exact test were used for categorical variables, and independent sample t-test was used for continuous variables. The association between each patient characteristic and non-attendance status was assessed using Binary Logistics Regression. Variables that showed statistical significance in univariate analysis were included in the multivariate logistic regression model to identify the independent risk factors associated with non-attendance. ResultsAmong the 59,748 outpatient appointments with medical imaging requests, 15.5% did not turn up for their appointments. Logistic regression indicated that patient's age, ethnicity, subsidy status, house ownership, living vicinity to regional hospital cluster, appointment wait times, appointment hours and appointment months were significant factors associated with the failure to attend scheduled radiological examinations. ConclusionEven though predictors of non-attendance remained consistent across medical imaging centres worldwide, Singapore reported a higher prevalence of missed appointments calling for future exploratory studies to understand the population's health-seeking behaviours and ordering patterns of clinicians. Implications for practiceComparison and identification of these predictors will assist in the design of targeted interventions that may improve patient's adherence and utilisation of imaging services.

Insurance Acceptance, Appointment Wait Time, and Dermatologist Access Across Practice Types in the US

In the 15 years since dermatology access was last investigated on a national scale, the practice landscape has changed with the rise of private equity (PE) investment and increased use of nonphysician clinicians (NPCs). To determine appointment success and wait times for patients with various insurance types at clinics with and without PE ownership. In this study, PE-owned US clinics were randomly selected and matched with 2 geographically proximate clinics without PE ownership. Researchers called each clinic 3 times over a 5-day period to assess appointment/clinician availability for a fictitious patient with a new and changing mole. The 3 calls differed by insurance type specified, which were Blue Cross Blue Shield (BCBS) preferred provider organization, Medicare, or Medicaid. Appointment success and wait times among insurance types and between PE-owned clinics and control clinics. Secondary outcomes were the provision of accurate referrals to other clinics when appointments were denied and clinician and next-day appointment availability. A total of 1833 calls were made to 204 PE-owned and 407 control clinics without PE ownership across 28 states. Overall appointment success rates for BCBS, Medicare, and Medicaid were 96%, 94%, and 17%, respectively. Acceptance of BCBS (98.5%; 95% CI, 96%-99%; P = .03) and Medicare (97.5%; 95% CI, 94%-99%; P = .02) were slightly higher at PE-owned clinics (compared with 94.6% [95% CI, 92%-96%] and 92.8% [95% CI, 90%-95%], respectively, at control clinics). Wait times (median days, interquartile range [IQR]) were similar for patients with BCBS (7 days; IQR, 2-22 days) and Medicare (7 days; IQR, 2-25 days; P > .99), whereas Medicaid patients waited significantly longer (13 days; IQR, 4-33 days; P = .002). Clinic ownership did not significantly affect wait times. Private equity-owned clinics were more likely than controls to offer a new patient appointment with an NPC (80% vs 63%; P = .001) and to not have an opening with a dermatologist (16% vs 6%; P < .001). Next-day appointment availability was greater at PE-owned clinics than controls (30% vs 21%; P = .001). Patients with Medicaid had significantly lower success in obtaining appointments and significantly longer wait times regardless of clinic ownership. Although the use of dermatologists and NPCs was similar regardless of clinic ownership, PE-owned clinics were more likely than controls to offer new patient appointments with NPCs.

Evaluating network adequacy of oral health services for children on Medicaid in Arizona.

PurposeInadequate networks can prevent patients from being able to see the providers that they trust and depend upon, especially for children insured through Medicaid. To improve our understanding of poor oral health care outcomes, we conducted a test of network adequacy among Medicaid pediatric dental providers in Arizona through a “secret shopper” phone survey.MethodsThis study tested multiple components of children's access to oral health care, including reliability of provider directory information, appointment availability at the practice level for children covered under Medicaid versus commercial insurance, and compliance with regulatory standards. We contacted individual providers, following a standardized script to schedule a routine appointment on behalf of a 5-year-old patient enrolled in either a Medicaid or commercial plan. We documented the time until the next available appointment, if the practice was reached, and if the practice accepted the specified insurance plan.ResultsWe identified, catalogued, and attempted to call a total of 185 unique practices across Arizona. In four counties, we were unable to identify a single pediatric oral health provider through health plan directories. We observed minimal differences in appointment wait times between callers with commercial insurance and those insured through Medicaid.ConclusionsOur findings underscore the need to improve the accessibility of pediatric health services, especially in rural regions. Facilitating access to routine and recommended oral health screenings for children enrolled in Medicaid is imperative to appropriate stewardship and fulfilling our commitment to provide this vital public health resource.

Reducing Waiting Time in the General Pediatric Clinic at Al Wakra Hospital, Qatar

Waiting times for clinic appointments constitute a key indicator of an outpatient department performance for access to care and patient satisfaction. This is particularly relevant for pediatric population. The Ministry of Public Health in Qatar set a waiting time of 28 days for patients to get new appointment in General Outpatient Department (GOPD). The current average waiting time to get a new appointment in the general pediatric clinic (GPC) at AWH is 57 days. As the aim is to decrease the average waiting time to get a new clinic appointment from 57 days to 28 days by the end of December 2018, and to meet the national targets set by the Ministry of Public Health. Using the Model for Improvement (MFI) will make it a Quality Improvement (QI) project. The MFI framework is designed to support organizations answering fundamental questions before agreeing on drivers for change. The implementation of change was be facilitated by the Plan-Do-Study-Act (PDSA) cycles methodology. The QI project team performed a root cause analysis using the Ishikawa diagram and identified the key contributing factors to the long waiting times to get a new appointment. Twenty-seven PDSA cycle ramps were designed with support of predictive tool to test innovative changes in current operational processes in an attempt to improve waiting time in the general pediatric clinic at Al Wakra Hospital. As a result, the monthly average number of referrals for GPC increased by 200% between the pre and post implementation periods. The average triage waiting time improved from 6 to 2.6 days in 2018 and the average become 1 day in 2019. Post-implementation the average waiting time for patients to get new appointment improved from 57 days to 28 days in 2018 and the average waiting time improved to 16 days in 2019. In conclusion The quality improvement project for the AWH general pediatric clinic demonstrates significant improvement in waiting times for new appointments, the recommendation for the hospital leadership would be to rollout the improvement methodology to other clinics that suffer from similar challenges.

Experiences of Canadian Parents of Young Children With Cleft Lip and/or Palate.

Prior literature has described the perspectives of parents of young children with clip lip and/or palate; however, few studies have described parents' experiences within a Canadian health care system. This study aims to better understand the experiences of parents of young children with cleft lip and/or palate seen at a Canadian tertiary care center and identify their care needs. In-depth semistructured interviews. Pediatric tertiary care center. Parents of children younger than 7 years of age with cleft lip and/or palate. From 14 interviews, 4 themes were identified. The diagnosis theme was associated with reactions, timing, and search for information. Key concerns within the theme of physiology and function were around feeding and speech. The health care experience theme included burden of care, peripheral hospitals and services, the cleft lip and palate clinic, and clinicians. The psychosocial theme included parents' reactions to their child's pain, coping strategies, family interactions, and school/day care experiences. Parents felt care could be improved by having: access to good information and community speech therapists, shorter appointment wait times, a peer support network, and increased cleft knowledge within their child's school and peer groups. The experience of parents of children with cleft lip and/or palate is complex but can be organized into 4 themes. Clinics may consider suggestions offered by parents to improve care. Future work should address parents' needs and aim to create a parent-reported quality-of-life measure specific to parents of young children with cleft lip and/or palate.

PMU11 Evaluation of Missed Physiotherapy Appointment and Its Influence on Cost, Efficiency and Patient Outcomes

Missed appointments (MAs) contribute to the rising costs of physiotherapy and are a significant challenge to healthcare administration, organisational workflow and health outcomes for patients. This study assessed prevalence and pattern of missed physiotherapy appointments, wait time, and its impact on cost, efficiency and patient outcome in Nigeria. A retrospective study was conducted at the Outpatient Physiotherapy Clinic of Obafemi Awolowo University, Ile-Ife, Nigeria. A total of 3243 physiotherapy appointments booked between 2009 and 2018 were assessed. Data were collected on socio-demographic and patient outcomes related to Mas. MAs was defined as any appointment where a patient did not show up at all, or attend to follow up appointment or notify staff of a cancellation. The total revenue loss due to MAs was calculated as a product of the total of MAs and per treatment cost. Descriptive of mean, standard deviation and frequency and inferential statistics of t-test were used to analyse the data. MAs constituted 1701 (52.5%) of all appointments and the average wait time for first appointment was 9.6 ± 23.2 days. The proportion of MAs was higher among females (50.2%), middle-aged adults (34-55 years) (31.7%), patients who were not resident close to the clinic (45.3%), patients with orthopaedic conditions (56.2%) and patients referred from orthopaedic surgeons (32.8%). There were significant associations (p < 0.05) between MAs and age, sex, location of patient’s residence and the source of referral. Considering the per treatment schedule cost of 1000 naira, a 52.5% MAs rate resulted in a lower efficiency of 76.6% with an efficiency ratio of 0.23. MAs for physiotherapy treatment poses a significant challenge on costs, efficiency and patients’ outcome. Thus, an innovative reminder system may help reduce patients’ non-attendance of physiotherapy and its consequences.

Accessing care in multidisciplinary pain treatment facilities continues to be a challenge in Canada

BackgroundMultidisciplinary pain treatment facilities (MPTFs) are considered the optimal settings for the management of chronic pain (CP). This study aimed (1) to determine the distribution of MPTFs across Canada, (2)...

Telemedicine for Acute Conditions During COVID-19: A Nationwide Survey Using Crowdsourcing.

Background: COVID-19 has resulted in a rapid and significant adoption of telemedicine for acute conditions. Understanding whether patient demand will last after the pandemic helps providers and payers make informed decisions about whether to continue adopting telemedicine. Objective: We examine user experience as well as process and patient outcomes of using telemedicine for acute conditions during COVID-19 and assess how patient outcomes are affected by waiting times and demographics. Materials and Methods: A survey was conducted via Amazon Mechanical Turk during June 17-29, 2020. Inclusion criteria were: (1) ≥18 years old, (2) residing in the United States, (3) used telemedicine for acute conditions after January, and 4) a human intelligence task approval rate of >95%. Process outcomes included patient waiting time with patient outcomes being satisfaction and future use intention. Bivariate analysis and regressions of the data were performed. Results: On average, respondents reported appointment wait time of 2.76 days and virtual office wait time of 19.44 min. Overall, respondents reported moderate satisfaction (mean 5.08-5.35 of 7) and future use intention (mean 5.10-5.32 of 7). Over 72% of the respondents were satisfied and had future use intention. Females, heavier internet users, and those on the higher/lower ends of the education spectrum reported better patient outcomes. Patients "visiting" a doctor experiencing eye problems, vis-à-vis other ailments, reported lower satisfaction and intention. Waiting time negatively associates with satisfaction. Conclusions: Given the satisfactory outcomes, the high demand for telemedicine may continue after the COVID-19 pandemic. However, whether providers will continue to offer telemedicine visits may require more evidence.

Analysis of availability of online dermatology appointments during the COVID-19 pandemic

To the Editor: ZocDoc is an online appointment scheduling platform that hosts thousands of independent practices and hospitals.1 Wait times for online dermatology appointments have been reported; to our knowledge, the impact of COVID-19 on appointment availability and wait times has not been studied.2 Our objective was to characterize dermatology appointment wait times on ZocDoc based on dermatologist density during the COVID-19 pandemic.

Factors Associated With Patient Ratings of Timeliness of Primary Care Appointments.

As access is the lowest rated dimension in surveys of outpatient experience, we sought to identify patient, practice, and provider factors associated with positive ratings of timeliness of primary care appointments. A cross-sectional study with multivariable, multilevel logistic regression was performed using survey responses from 236 695 individuals receiving care in the Veterans Health Administration (VA). Top box ratings (response of “always”) for whether the patient reported receiving an appointment as soon as they needed in primary care for routine care and for care needed right away were the main outcomes. Independent variables capturing patient, practice, and provider factors were obtained from survey responses and VA databases. Degree of continuity with primary care provider and duration of relationship were strongly associated with higher ratings. Shorter primary care appointment wait times for both new and returning patients were associated with higher ratings. Independent wait times for mental health and specialty appointments had no effect. Older age, better self-reported physical and mental health, lower disease complexity, and rural residence were patient factors associated with higher ratings while gender, race, ethnicity, and education had little effect. Measures of continuity with primary care provider as well as appointment wait times have strong association with positive patient ratings of appointment timeliness. Patients treated in Veterans Affairs clinics may value continuity with their primary care provider over longer times. Initiatives to improve access could focus on improving continuity and ensuring efforts to improve access do not impact continuity.

An Innovative Model for Providing Dermatology Services Within Primary Care.

ObjectiveDermatologic complaints are common in outpatient pediatrics. However, pediatric dermatology specialty care can be difficult to access. We aimed to test the feasibility of co-locating dermatology services within primary care and increase the proportion of patients treated for basic skin complaints within the medical home while decreasing wait times.MethodsThe Rapid Assessment of Skin Health (RASH) clinic was created within a hospital-based primary care clinic in 11/2013. The clinic was staffed by 2 pediatricians trained in the dermatology department and supported with specialist advice as needed. Referral volume and wait times to dermatology and RASH clinic were tracked for visits between 11/1/12 and 10/31/18. A chart review was also conducted on a subset of RASH clinic visits. Primary care providers (PCPs) were surveyed about their experiences.ResultsFifty-eight percent of patients referred for a dermatologic complaint were scheduled in RASH clinic. Wait times for new patient appointments in RASH clinic were significantly shorter than for new dermatology appointments in the previous 12 months (mean 36 days vs 65 days, P < .001). The monthly number of referrals to dermatology also decreased significantly after the RASH clinic opened (24/month vs 12/month, P < .001). Ten percent of RASH patients were referred on to dermatology. In a survey of PCPs (N = 67), 76% said the RASH clinic was “extremely/very helpful.”ConclusionsProviding dermatologic care to low or moderate complexity patients within the medical home is feasible and leads to better access to care. This innovative model could be spread to other clinics and subspecialties.

Evaluating the cost and wait-times of a task-sharing model of care for diabetic eye care: a case study from Australia

ObjectivesTo determine whether a collaborative model of care that uses task-sharing for the management of low-risk diabetic retinopathy, Community Eye Care (C-EYE-C), can improve access to care and better use...

COVID-19’s Impact on Genetics at One Medical Center in New York

COVID-19’s Impact on Genetics at One Medical Center in New York

Implementation of a pediatric provider-to-provider store-and-forward teledermatology system: Effectiveness, feasibility, and acceptability in a pilot study.

Long wait times for in-person appointments in pediatric dermatology can lead to delays in specialty care, additional health system touchpoints, patient and family dissatisfaction, poorer outcomes, and increased overall health care costs. Store-and-forward teledermatology may address these challenges and improve access to care in pediatric dermatology. We describe a prospective, non-blinded cohort study with follow-up surveys conducted from March 1, 2018, to September 20, 2018. The study was conducted at a single center, in primary care and specialist settings. Patients included were <18years old and received care at one of our affiliated primary care sites. Primary care providers submitted teledermatology consultations through a shared electronic medical record. A board-certified pediatric dermatologist evaluated each consultation; primary care providers conveyed recommendations to families. Forty-three consultations for patients (23 male, 20 female; median age: 7years [IQR: 2.4-12]) were entered by primary care providers. Median time from consult request to dermatologist initiating consult was 12.1hours [IQR: 1.9-18.8]; median time to complete consult note was 7minutes [IQR: 5-10.5]. Median time from primary care provider initially consulting to conveying teledermatology recommendations to families was 3days [IQR: 1-5]. All but one consult (42/43, 98%) were completed in the intended workflow. Follow-up in-person visits with pediatric dermatologists occurred with 10/43 (23%) patients. In follow-up surveys, parents were 83% likely to recommend the service to family and friends. All primary care providers and dermatologists felt the service improved quality of care. Provider-to-provider teledermatology consultation appears to be a feasible and acceptable method of providing care quickly and effectively to pediatric patients.