Virtual Care in Rhinology

Smith et al. Journal of Otolaryngology - Head and Neck Surgery https://doi.org/10.1186/s40463-021-00505-1 (2021) 50:24 ORIGINAL RESEARCH ARTICLE Open Access Virtual Care in Rhinology Kristine A. Smith1* , Andrew Thamboo2, Yvonne Chan3, Christopher J. Chin4, Megan Werger5 and Brian Rotenberg6 Abstract Background: The SARS-CoV-2 (COVID) pandemic has resulted in an increase in virtual care. While some specialties are well suited to virtual care, Otolaryngology – Head and Neck Surgery could be limited due to reliance on physical examination and nasal endoscopy, including Rhinology. It is likely virtual care will remain integrated for the foreseeable future and it is important to determine the strengths and weaknesses of this treatment modality for rhinology. Methods: A survey on virtual care in rhinology was distributed to 61 Canadian rhinologists. The primary objective was to determine how virtual care compared to in-person care in each area of a typical appointment. Other areas focused on platforms used to deliver virtual care and which patients could be appropriately assessed by virtual visits. Results: 43 participants responded (response rate 70.5%). The majority of participants use the telephone as their primary platform. History taking and reviewing results (lab work, imaging) were reported to be equivalent in virtual care. Non-urgent follow up and new patients were thought to be the most appropriate for virtual care. The inability to perform exams and nasal endoscopy were reported to be significant limitations. Conclusion: It is important to understand the strengths and limitations of virtual care. These results identify the perceived strengths and weaknesses of virtual care in rhinology, and will help rhinologists understand the role of virtual care in their practices. Keywords: Virtual care, Rhinology, COVID-19, Coronavirus Introduction With the emergence of the SARS-CoV-2 virus in December 2019 and the associated pandemic declared in March 2020, there was a rapid transition from in-person appointments to virtual care for many medical practices [1]. Locoregional lockdowns and restrictions on inperson appointments necessitated another form of care to ensure patients were affected as minimally as possible. Virtual visits provided an alternative to in-person care. For many, this was seen as a temporary measure that would cease when the SARS-CoV-2 outbreak subsided. Unfortunately, it appears the current coronavirus is not going to dissipate like its predecessors, SARS-CoV-1 and * Correspondence: 1 Department of Otolaryngology - Head and Neck Surgery, University of Manitoba, GB421B – 820 Sherbrook Street, Winnipeg, Manitoba, Canada Full list of author information is available at the end of the article MERS. Subsequently physical distancing and restrictions on in-person visits will likely be present for the foreseeable future. The need for physical distancing in hospitals and private clinics has resulted in a significant reduction in the availability of in-person appointments. Virtual visits can help balance the need to reduce in-person practice volumes and meet the needs of patients awaiting new consultations and follow up care. While telemedicine has been available for years, its use is generally limited to patients who live in remote or difficult to access areas. Now, virtual care is nearly ubiquitous in North America. There are many areas in medicine which are well suited to virtual care. However, Otolaryngology – Head and Neck Surgery (OtoHNS) is a specialty that often relies on physical examination to aid in diagnosis. Some components of the physical exam may be possible through © The Author(s). 2021 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Smith et al. Journal of Otolaryngology - Head and Neck Surgery (2021) 50:24 various virtual platforms, but there is currently no alternative for endoscopy, an important component of an otolaryngologic assessment. As a result, virtual visits may limit an Otolaryngologist’s ability to accurately diagnose and manage disease. Additional outbreaks of SARS-CoV-2 virus are already occurring in some areas of the world. As these viral outbreaks ebb and flow, transitions between a state of lockdown and cautious reopening are expected. Virtual care will likely play a significant role in physicians’ ability to provide continuity of care during times of greater restrictions, and will likely be present in some form as long as physical distancing is needed. Otolaryngology is a diverse subspecialty, which treats a highly varied complement of disease. Within Rhinology, a subspecialty of Otolaryngology, there are some circumstances where virtual care may be comparable to traditional in-person care and others where it may be less effective. The goal of this study is to assess the opinions of the role of virtual care in Rhinology, to help understand the perceived benefits and drawbacks of this care modality. Methods Study design and subjects This study was a cross-sectional survey of Canadian rhinologists. Participants were identified from an email list from the Canadian Rhinology Working Group. Inclusion criteria were Canadian Otolaryngologists with fellowship training in rhinology or an emphasis in their practice on rhinology. A 32-question survey was developed by the authors, which primarily focused on determining how virtual care compared to in-person care in each area of a typical appointment (history, physical exam, diagnosis, treatment, etc). Other areas of the survey focused on platforms used to deliver virtual care and which presenting complaints were thought to be equally assessed by a virtual visit compared to in-person assessments. The survey is available for review in supplemental material 1. Following development of the survey, it was inputted into SurveyMonkey (San Mateo, California, 1999–2020). In June 2020, an initial email invitation to the survey was distributed. Two subsequent reminder emails were sent approxim (...truncated)