Social and Environmental Benefits of Pediatric Infectious Disease Telemedicine

Abstract Corresponding Author: Lydia Lu, Children’s Healthcare of Atlanta, 2174 North Druid Hills Road NE, Atlanta, GA 30329, [email protected], 404-785-5733 Alternate Corresponding Author: Preeti Jaggi, Emory University, Division of Pediatric Infectious Disease, 2015 Uppergate Drive, Suite 534, Atlanta, GA 30322, [email protected], 404-785-0977 No conflicts of interest. Background Telemedicine is supported by the Infectious Diseases Society of America (IDSA) as an evidence-based approach to provide timely, cost-effective infectious disease (ID) management to patients including resource-limited populations, patients with chronic diseases, and patients on outpatient parenteral antimicrobial therapy (OPAT). However, prior to the COVID-19 pandemic, implementation had been modest due to limited experience and reimbursement challenges. Following the Centers for Medicare and Medicaid Services emergency declaration supporting operations and payment for telehealth, our division launched an outpatient telemedicine clinic for direct-to-patient pediatric ID management in April 2020. We evaluated our services for safety and family satisfaction, while quantifying potential benefits to families and public health through telemedicine. Methods We retrospectively reviewed electronic charts of all patients receiving pediatric ID management via telemedicine from April 2020 to September 2023. Attendance and patient satisfaction data for both telemedicine and in-person visits were obtained from our health system for comparison. Patient addresses were entered into a free-source mapping program (Google maps) targeting a weekday morning clinic to predict travel times and distances which would have been required for in-person presentation. Environmental Protection Agency emissions calculators were used to estimate the carbon footprint off-set by our telemedicine visits. Results From April 2020 – September 2023, one physician assistant and 6 physicians in our pediatric ID division completed 217 telemedicine encounters for 152 unique patients (ages 1 month – 20 years). Among the 152 patients identified, 56 (38.8%) were new patients to infectious disease clinic, and 96 (63.2%) were established patients with the infectious disease service (including recently hospitalized patients). Subsequently, 34 (22.4%) of patients had more than one telemedicine visit. The vast majority of visits were conducted by the physician assistant (>50%). An estimated total of 31,214.8 round-trip miles of travel were saved during this period through providing care via telemedicine; a median of 95.3 miles (IQR, 57.3-200.0) per visit. The median travel time saved per visit was 165 minutes (IQR, 120-255). Nearly half (48.7%) of patients receiving telemedicine lived >50 miles from our clinic. Based on EPA estimates, the total carbon footprint offset by telemedicine visits during this period was equal to 12,829 kg. Clinic attendance and family satisfaction scores were no different than in-clinic visits for the same period, and we had no adverse clinical outcomes in our telemedicine cohort. Conclusion Telemedicine services for pediatric subspecialties like ID are needed in the context of growing populations with decreased access to specialized care. We successfully provided direct-to-patient ID management for a number of diagnoses, with no adverse outcomes, and with patient satisfaction and clinic attendance comparable to in-person clinic visits. Providing telemedicine to our population had the added public health benefit of decreasing greenhouse gas emissions and decreasing the direct and indirect cost of medical care to individual patients.