Telehealth during COVID-19 restrictions in patients with cardiovascular disease: impact on medication prescriptions and patient satisfaction.

Publisher: Blackwell Science Asia Country of Publication: Australia NLM ID: 101092952 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1445-5994 (Electronic) Linking ISSN: 14440903 NLM ISO Abbreviation: Intern Med J Subsets: MEDLINE

Original Publication: Carlton, Vic. : Blackwell Science Asia, c2001-

COVID-19*/epidemiology ; COVID-19*/prevention & control ; Patient Satisfaction* ; Telemedicine* ; Cardiovascular Diseases*/drug therapy ; Cardiovascular Diseases*/epidemiology; Humans ; Male ; Female ; Retrospective Studies ; Middle Aged ; Aged ; Australia/epidemiology ; Drug Prescriptions/statistics & numerical data ; Aged, 80 and over

Background and Aims: Telehealth plays an integral part in healthcare delivery. The impact of telehealth and the COVID-19 pandemic on medication prescribing and patient satisfaction with telehealth in cardiology clinics remains unknown.
Methods: A retrospective study of cardiology clinic patients at an Australian tertiary hospital was conducted; 630 patients seen before the COVID-19 pandemic (0.6% telehealth) and 678 during the pandemic (91.2% telehealth) were included. Medication changes, new prescriptions and time to obtaining prescriptions after clinic were compared. To evaluate patients' experiences, cardiology clinic patients reviewed during the pandemic were prospectively invited to participate in an electronic survey sent to their mobile phones.
Results: The overall rates of medication changes made in the clinic between the prepandemic and the pandemic periods did not differ significantly (26.9% vs 25.8%). Compared with prepandemic, new cardiac medication prescriptions during clinic were significantly less (9.3% vs 2.5%; P < 0.0001) and recommendations to general practitioners (GP) to initiate cardiac medications were significantly more (2.6% vs 9.1%; P < 0.0001). Time to obtaining new prescriptions was significantly longer in the pandemic cohort (median 0 days (range: 0-32) vs 10.5 days (range: 0-231); P < 0.0001). Two hundred forty-three (32.7%) patients participated in the survey; 50% reported that telehealth was at least as good as face-to-face consultations. Most patients (61.5%) were satisfied with telehealth and most (62.9%) wished to see telehealth continued postpandemic.
Conclusion: Telehealth during the COVID-19 pandemic was associated with greater reliance on GP to prescribe cardiac medications and delays in obtaining prescriptions among cardiology clinic patients. Although most patients were satisfied with telehealth services, nearly half of the cardiac patients expressed preference towards traditional face-to-face consultations.
(© 2024 The Authors. Internal Medicine Journal published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Physicians.)

Maung KK, Marques‐Vidal P. Impact of COVID‐19 pandemic on cardiovascular diseases hospitalisation, management and mortality in Switzerland. Open Heart 2023; 10: e002259.
Dao T, Long K, Maier AB. Characteristics and perceptions of utilising telehealth for predominantly middle‐aged to older, metropolitan‐based general medical patients. Intern Med J 2023; 53: 2247–2256.
Isautier JMJ, Copp T, Ayre J, Cvejic E, Meyerowitz‐Katz G, Batcup C et al. People's experiences and satisfaction with telehealth during the COVID‐19 pandemic in Australia: cross‐sectional survey study. J Med Internet Res 2020; 22: e24531.
Yusuf S, Islam S, Chow CK, Rangarajan S, Dagenais G, Diaz R et al. Use of secondary prevention drugs for cardiovascular disease in the community in high‐income, middle‐income, and low‐income countries (the PURE Study): a prospective epidemiological survey. Lancet 2011; 378: 1231–1243.
Kravitz RL, Hays RD, Sherbourne CD, DiMatteo MR, Rogers WH, Ordway L et al. Recall of recommendations and adherence to advice among patients with chronic medical conditions. Arch Intern Med 1993; 153: 1869–1878.
Newton PJ, Davidson PM, Reid CM, Krum H, Hayward C, Sibbritt DW et al. Acute heart failure admissions in New South Wales and the Australian Capital Territory: the NSW HF Snapshot Study. Med J Aust 2016; 204: 113.e1–113.e8.
Greene SJ, Butler J, Albert NM, DeVore AD, Sharma PP, Duffy CI et al. Medical therapy for heart failure with reduced ejection fraction. J Am Coll Cardiol 2018; 72: 351–366.
Ambrosy AP, Fonarow GC, Butler J, Chioncel O, Greene SJ, Vaduganathan M et al. The global health and economic burden of hospitalizations for heart failure: lessons learned from hospitalized heart failure registries. J Am Coll Cardiol 2014; 63: 1123.
Newby LK, Allen LaPointe NM, Chen AY, Kramer JM, Hammill BG, DeLong ER et al. Long‐term adherence to evidence‐based secondary prevention therapies in coronary artery disease. Circulation 2006; 113: 203–212.
Wolfe NK, Mitchell JD, Brown DL. The independent reduction in mortality associated with guideline‐directed medical therapy in patients with coronary artery disease and heart failure with reduced ejection fraction. Eur Heart J Qual Care Clin Outcomes 2021; 7: 416–421.
Boden WE, O'Rourke RA, Teo KK, Hartigan PM, Maron DJ, Kostuk WJ et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med 2007; 356: 1503–1516.
Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. J Am Coll Cardiol 2022; 79: e263–e421.
Miller LE, Bhattacharyya N. Antibiotic prescribing for acute rhinosinusitis: in‐person versus virtual visits during Covid‐19. Laryngoscope 2021; 131: E2121–E2124.
Wabe N, Thomas J, Sezgin G, Sheikh MK, Gault E, Georgiou A. Medication prescribing in face‐to‐face versus telehealth consultations during the COVID‐19 pandemic in Australian general practice: a retrospective observational study. BJGP Open 2022; 6: BJGPO.2021.0132.
Alexander GC, Tajanlangit M, Heyward J, Mansour O, Qato DM, Stafford RS. Use and content of primary care office‐based vs telemedicine care visits during the COVID‐19 pandemic in the US. JAMA Netw Open 2020; 3: e2021476.
Mebazaa A, Davison B, Chioncel O, Cohen‐Solal A, Diaz R, Filippatos G et al. Safety, tolerability and efficacy of up‐titration of guideline‐directed medical therapies for acute heart failure (STRONG‐HF): a multinational, open‐label, randomised, trial. Lancet 2022; 400: 1938–1952.
Tan T, Chan S, Ind M, Pace G, Bailey J, Reed K et al. Benefits and challenges of electronic prescribing for general practitioners and pharmacists in regional Australia. Aust J Rural Health 2023; 31: 776–781.
Lau P, Tran MT, Kim RY, Alrefae AH, Ryu S, Teh JC. E‐prescription: views and acceptance of general practitioners and pharmacists in Greater Sydney. Aust J Prim Health 2024; 30.
Imlach F, McKinlay E, Kennedy J, Morris C, Pledger M, Cumming J et al. E‐prescribing and access to prescription medicines during lockdown: experience of patients in Aotearoa/New Zealand. BMC Fam Pract 2021; 22: 1–12.
Mian M, Sreedharan S, Giles S. Increased dispensing of prescription medications in Australia early in the COVID‐19 pandemic. Med J Aust 2021; 214: 428–429.
Johnson BA, Lindgren BR, Blaes AH, Parsons HM, LaRocca CJ, Farah R et al. The new normal? Patient satisfaction and usability of telemedicine in breast cancer care. Ann Surg Oncol 2021; 28: 5668–5676.
Singh A, Mountjoy N, McElroy D, Mittal S, Al Hemyari B, Coffey N et al. c. JMIR Cardio 2021; 5: e25074.
Hays RD, Skootsky SA. Patient experience with in‐person and telehealth visits before and during the COVID‐19 pandemic at a large integrated health system in the United States. J Gen Intern Med 2022; 37: 847–852.

National Heart Foundation Post Doctoral Scholarship

Keywords: COVID‐19; cardiovascular; medication prescription; telehealth

Date Created: 20240320 Date Completed: 20240818 Latest Revision: 20240818

20240819

10.1111/imj.16378

38506546