The impact of COVID-19 and virtual clinics on physician behaviour in respiratory ambulatory care

Abstract

The COVID-19 pandemic has resulted in restructuring of services across healthcare settings. The adoption of virtual clinics (VCS) has been almost universal. The aim of VCS is to provide patient care whilst reducing the number of potential close contacts. This study aimed to assess care provided in specialty tertiary and quaternary respiratory clinics during 2020 when in-person (IP) and VCS occurred, compared to 2019

An audit of all consults at the Respiratory and Interstitial Lung Disease (ILD) Clinics at St. Vincent’s University Hospital from May to August in 2019 and 2020 was conducted. Retrospective data was obtained from electronic patient records on treatment changes (Tx), diagnostic investigations (Ix) ordered, discharges(d/c) and mean follow up time. Statistical analysis was performed on GraphPad Prism 8.0 data using Chi-Square testing and students t-test.

1306 consults were analysed, 689 IP consults in 2019 were compared to 617 consults in 2020 (512 virtual, 105 in-person ). In 2020, fewer Ix were ordered (55%v62%,p=0.028), less Tx made (16%v31%,p<0.0001) and shorter follow-up arranged (4.2v5 months, p=0.002). In 2020, IP consults resulted in more Ix (p=0.0001) and Tx (p<0.0001) occurring than virtual consults. In the 2020 general respiratory clinic there were lower Tx and Ix compare to 2019. In the ILD clinic there were similar diagnostic investigations but less treatment changes.

VCS have been essential to maintain services. The behaviour of clinicians is altered, this may have implications for tertiary and quaternary care. If telemedicine is to maintain the same standards of care, then it will be essential to improve the ability to be consistent in quality of care.