Remote COPD Patient Follow-Up During COVID-19

Doctor on phone holding X-ray

Before the COVID-19 pandemic, it was quite rare to schedule virtual appointments with your doctors. Very quickly, the health care system experienced an increased need to develop a new approach for patient follow-ups that minimized risk to the patient’s health, especially those with chronic lung disease.

What is a remote follow-up?

A remote, or virtual, follow-up is any appointment with your treating physician or healthcare professional, subsequent to the diagnosis of a disease or condition, that is carried out via phone or a video-conferencing platform.

In other words, it is any form of communication with your healthcare team that does not take place in-person at a hospital, clinic, or center.

Why might my doctor recommend a virtual appointment?

Before the COVID-19 pandemic, it was quite rare to schedule virtual appointments with your doctors. Very quickly, the health care system experienced an increased need to develop a new approach for patient follow-ups that minimized risk to the patient’s health, especially those with chronic lung disease.1 Remote follow-ups allow patients normally seen in hospitals and/or clinics to continue to receive treatment. In the future, this could have a positive impact on efficiency and the capacity the health care system.2

Your doctor might have different reasons for wanting to speak with you virtually versus in-person, but the following are some of the more common reasons:

  • Government social distancing restrictions (ie. limiting the number of persons allowed in a public space at one time)
  • Reduce the risk of transmission of coronavirus by the patient

According to current evidence, patients with COPD do not seem to have an increased risk of developing COVID-19. However, they are at greater risk of developing severe COVID-193-4, hospitalization for COVID-19 and may be at increased risk of developing severe symptoms resulting in fatal outcomes.5-8

Virtual or in-person. How to decide?

The first thing your physician will do is determine whether you are a good candidate to have a virtual follow-up, or whether it would be better to see you in-person. There are several factors that are taken into account and it will be up to their discretion to decide which route is more suitable.1 This decision will also depend on current governmental safety guidelines in place.

Inclusion criteria for remote follow-ups

You would be considered for a remote follow-up if the following situations apply1:

  • You and/or your caregiver can understand the remote process and are technically proficient.
  • You and/or your caregiver are able to provide information clearly via telephone and/or video-conference;
  • It is a regular COPD follow-up, or you are being followed for a known condition;
  • Your physician has access to your medical records and any recent test results;
  • You have access to your prescription and medication (pre-existing or new) and can arrange a follow up, if necessary.

Exclusion criteria for remote follow-ups

You would not be considered for a remote follow-up if the following situations apply1:

  • You, the patient or caregiver have difficulty providing information via video/teleconference;
  • Immediate medical attention is needed due to the presence of severe medical symptoms;
  • There are changes in your symptoms important enough to require further medical work-up or the need for a physical exam or test(s).
  • Treatment can only be given in-person and cannot be given at home.

Prioritizing patient visits

Even due to the increased safety measures surrounding in-person visits, which affects the number of appointment slots, your physician may feel that you need to be seen in-person and not remotely. So they will consider the following when prioritizing1:

  • Your disease severity (symptoms burden and risk of exacerbations);
  • Any recent emergency department visits and/or hospital admissions;
  • Any associated significant comorbidities;
  • Your age
  • If you are living alone

What to expect during a remote follow-up

Apart from the fact that your appointment is taking place over the phone, or video call, you should expect a very similar process and service to when you have an appointment in-person. There will be a couple of extra steps to ensure doctor-patient confidentiality is not broken, however.

Here is a step-by-step process of what you could expect to occur during your remote follow-up1:

  1. The call will start, and your physician will introduce themselves and any other healthcare professionals that may be with them (case manager, student, resident, etc.). They should also inform you if you are on speakerphone.
  2. The physician will confirm they are indeed speaking with the right patient and ask for consent to continue the conversation.
  3. Before discussing any medical aspects, your physician might want to check you can hear them properly or if there are any technical issues. It would be a good idea for you to do the same and ask what to do if the connection fails.
  4. The physician will also ask if there are any others on your end listening to the conversation. If so, you would need to consent to them listening, or reschedule the call for another time when they would not be present.
  5. Once steps 1-4 are complete, the physician will begin the follow-up. They will ask questions relating to:
    • Any changes in your symptoms;
    • Any experience with, or exposure to COVID-19;
    • Your Action Plan;
    • Any recent hospital admission or ER visits;
    • The integration of your self-management techniques;
    • Any need to renew your medications
    • Any other issues you wish to discuss.
  6. At the end of the call, feel free to summarize the main discussion points and issues raised as well as any treatment plan or intervention agreed upon.
  7. If applicable, set up a date for the next follow-up.

Follow-ups if you have developed COVID-19

As mentioned earlier, COPD patients are at higher risk of developing severe COVID-19 which could require prolonged ICU stays.3 Whether you had a mild or severe COVID-19 episode, your treating physician may need to follow up with you more frequently, especially if they suspect there could be a need for oxygen therapy1. Your physician will use their expert opinion and consult available data to determine the best course of action for you.

It is also possible that you will be sent for a chest X-ray and/or CT scan between 6 months and 1-year post-recovery in order to monitor any damages sustained during the COVID-19 episode.1