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Telehealth in the time of COVID-19: Gastroenterologists' use and attitudes [Meeting Abstract]

Snell, D B; Wallace, T; Pochapin, M B; Gross, S A; Brodsky, T
INTRODUCTION: Telehealth involves the use of electronic information and telecommunications to promote healthcare. Physician experience is critical in assessing the impact of telehealth on clinical outcomes and utilization. Gastroenterologists' use and attitudes towards telehealth are largely unknown. We aimed to identify gastroenterologists' professional attitudes towards their use of telehealth and its effect on patient care during the COVID-19 pandemic.
METHOD(S): We performed a cross sectional survey of outpatient gastroenterologists and hepatologists at a single tertiary academic medical center in June 2020. Clinicians were invited to participate in an electronic survey. Survey questions involved either single or multiple categorical responses.
RESULT(S): A total of 46 respondents (51 +/- 14 years old) participated, 70% of which were male. 44 (96%) respondents had no telehealth experience prior to the pandemic. Clinicians conducted 19 +/- 13 visits weekly with a mean length of 24 +/- 9 minutes. 88% of providers reported telehealth allowed for increased flexibility, both in patient scheduling and their personal lives. Telehealth was always or usually effective in addressing patients' clinical needs 91% of the time. 29 (63%) respondents estimated that 10% or fewer patients required in-person follow-up. Clinicians estimated 93% of patients desired the continued option of telehealth, and 42 (91%) providers wanted to continue telehealth in some capacity, conditional on reimbursement. Those interested would use telehealth for follow-up visits (28%), on a patient-by-patient basis (23%), or for new visits (20%). While 21 (46%) respondents felt that telehealth and in-person visits required equal effort, 16 (35%) felt telehealth required more effort. Reasons cited for telehealth requiring more effort included coordination of care (30%), technical difficulty for the patient (20%), and more charting (17%).
CONCLUSION(S): While most clinicians had no telehealth experience before the pandemic, a majority were interested in using telehealth in the future, citing increased flexibility for both provider and patient. Physicians felt that telehealth was effective in addressing patients' needs. However, many felt that telehealth required more effort, particularly in regard to coordination of care and technical difficulties. Newer telehealth platforms should address connectivity issues. Future studies should focus on patients' attitudes towards telehealth, and the effect of telehealth on healthcare outcomes, utilization and costs
ISSN: 1572-0241
CID: 4720482

Case Series: Change in Genotype in Patients with Chronic Hepatitis C [Meeting Abstract]

Brodsky, Tamara; Dieterich, Douglas; Patel, Anna; Olson, Mary; Harty, Alyson; Jacobson, Ira M
ISSN: 1572-0241
CID: 2571412

Hepatic steatosis: correlations of body mass index, CT fat measurements, and liver density with biopsy results

Gaba, Ron C; Knuttinen, M Grace; Brodsky, Tamara R; Palestrant, Sarah; Omene, Benedictta O; Owens, Charles A; Bui, James T
PURPOSE: To assess the relationship between body mass index (BMI), subcutaneous and intra-abdominal fat, liver density, and histopathologic hepatic steatosis. MATERIALS AND METHODS: In this retrospective study, 143 patients (male/female, 67/76; mean age, 50 years) underwent a non-targeted transjugular (n = 125) or percutaneous (n = 18) liver biopsy between 2006 and 2010. The biopsy indications included chronic liver parenchymal disease staging (n = 88), elevated enzymes (n = 39), or other reasons (n = 16). The BMI and non-contrast liver computed tomography liver density were recorded for each patient. The thicknesses of the anterior, posterior, and posterolateral subcutaneous fat, along with the intra-abdominal fat, were measured. The values were then correlated with histopathologic steatosis. RESULTS: Of the patients, 47/143 (32%), 39/143 (28%), and 57/143 (40%) were normal weight, overweight, and obese, respectively. Steatosis was present in 13/47 (28%) of normal weight, 18/39 (46%) of overweight, and 38/57 (67%) of obese patients. Significant differences in BMI (26.7 kg/m(2) vs. 31.7 kg/ m2 vs. 35.0 kg/m(2), P < 0.001), liver density (52.8 HU vs. 54.4 HU vs. 42.0 HU, P < 0.001), anterior subcutaneous (1.8 cm vs. 2.4 cm vs. 2.9 cm, P < 0.001), posterolateral subcutaneous (2.8 cm vs. 3.2 cm vs. 4.4 cm, P < 0.004), posterior subcutaneous (1.9 cm vs. 2.5 cm vs. 3.4 cm, P < 0.001), and intra-abdominal fat thickness (1.1 cm vs. 1.3 cm vs. 1.4 cm, P < 0.013) were identified in patients with different degrees of steatosis (none, minimal to mild, moderate to severe, respectively). BMI (r = 0.37, P < 0.001) and the anterior subcutaneous fat (r = 0.30, P < 0.001) had a moderate correlation with the presence of liver steatosis. A combination of a BMI >/= 32.0 kg/ m(2) and an anterior subcutaneous fat thickness >/= 2.4 cm had a 40% sensitivity and 90% specificity for the identification of steatosis. CONCLUSION: Increase in the anthropomorphic metrics of obesity is associated with an increased frequency of liver steatosis.
PMID: 22258794
ISSN: 1305-3825
CID: 378552