The COVID-19 pandemic and transition to telehealth: appointment attendance and patient perspectives at an adult HIV clinic

OA13.04 I. Auchus; K. Jaradeh; A. Tang; B. Boslett and J. Marzan University of California, 360 Wellness Center, San Francisco, United States https://doi.org/10.1002/jia2.25659 Please Note: Illustration(s) are not available due [...]
Background: In the United States, up to 35% of HIV primary care patients struggle to routinely attend follow-up appointments. The COVID-19 pandemic forced many institutions to transition to a tele-health-focused model of care to maintain patient and provider safety. However, it was unknown how telehealth would impact patient attendance and perceptions about their care, particularly in populations at high risk of appointment non-adherence. To understand the impact of telehealth on retention in care for a vulnerable HIV-infected population, we assessed patient perspectives of telehealth and its effect on appointment attendance. Methods: We studied patients at the UCSF 360 Wellness Center, an HIV Primary Care Clinic at the University of California, San Francisco, during the 2019 to 2020 fiscal year. To assess the effect of the city-wide shelter-in-place orders and subsequent transition to telehealth, we compared appointment attendance before and after the order. Patient perceptions were collected via anonymous survey through a secure online portal. The survey included multiple-choice questions and free-text responses. Patients who did not have portal access were reached by telephone. Responses were analyzed and coded for themes. Results: Before March 16, telehealth comprised 5.2% of all clinic visits; after, telehealth comprised 86.9% of visits. No-show rates across all in-person visits before March 16th averaged 16.5% during the prior 6 months. Telehealth visits after March 16th had a no-show rate of 13.7%. Of the 134 survey responses, 19.6% of patients reported preference for in-person visits, 9.8% reported preference for tele-health visits, and 70.7% had no preference. Perceived strengths of telehealth included: 1) improved convenience; 2) safety in avoiding other patients; and 3) increased privacy. Several disadvantages included: 1) technical barriers; 2) lack of familiarity with video visit platform; and 3) lack of human connection as compared to in-person visits. Conclusions: The majority of our respondents (80.5%) said they are equally or more likely to attend telehealth visits as compared to in-person visits, and our data demonstrated improvement in appointment attendance. We plan to continue telehealth visits as a permanent and prevalent visit option to support HIV care for our patients. To further improve the telehealth experience, patients would benefit from more robust technical support.