The Logistics of Medication and Patient Flow in Video-Based Virtual Clinics During a Sudden COVID-19 Outbreak in Taiwan: Observational Study

Abstract

Background: The COVID-19 pandemic was well controlled in Taiwan until an outbreak in May 2021. Telemedicine was rapidly implemented to avoid further patient exposure and to unload the already burdened medical system.

Objective: To understand the effect of COVID-19 on the implementation of video-based virtual clinic visits during this outbreak, we analyzed the logistics of prescribing medications and patient flow for such virtual visits at a tertiary medical center.

Methods: We retrospectively collected information on video-based virtual clinic visits and face-to-face outpatient visits from May 1 to August 31, 2021, from the administrative database at National Taiwan University Hospital. The number of daily new confirmed COVID-19 cases in Taiwan was obtained from an open resource.

Results: There were 782 virtual clinic visits during these 3 months, mostly for the departments of internal medicine, neurology, and surgery. The 3 most common categories of medications prescribed were cardiovascular, diabetic, and gastrointestinal, of which cardiovascular medications comprised around one-third of all medications prescribed during virtual clinic visits. The number of virtual clinic visits was significantly correlated with the number of daily new confirmed COVID-19 cases, with approximately a 20-day delay (correlation coefficient 0.735; P<.001). The patient waiting time for video-based virtual clinic visits was significantly shorter compared with face-to-face clinic visits during the same period (median 3, IQR 2-6 min vs median 20, IQR 9-42 min; rank sum P<.001). Although the time saved was appreciated by the patients, online payment with direct delivery of medications without the need to visit a hospital was still their major concern.

Conclusions: Our data showed that video-based virtual clinics can be implemented rapidly after a COVID-19 outbreak. The virtual clinics were efficient, as demonstrated by the significantly reduced waiting time. However, there are still some barriers to the large-scale implementation of video-based virtual clinics. Better preparation is required to improve performance in possible future large outbreaks.

Keywords: COVID-19; telemedicine; video-based virtual clinic.

Figure 1

The workflow of our video-based virtual visit. (1) Appointment: eligible patients could make an appointment online and download the necessary software in advance. (2) Virtual visit: patients enter the virtual waiting room before the appointment time. Patients show their National Health Insurance card to the camera to confirm their identity. The physician then starts the virtual visit. (3) Pay the bill: patients or caregivers can pay the bill online (*or inside the hospital, according to their choice). (4) Medication pick-up: patients or caregivers pick up their medications via a drive-through station served by a pharmacist outside the hospital (*or inside the hospital, according to their choice).

Figure 2

Time curve of daily new COVID-19 cases (gray dashed line), NTUH face-to-face clinic visits (blue dotted line), and NTUH virtual clinic visits (black line; the scale is shown on the secondary y-axis on the right side) between May 1 and August 31, 2021. After the community outbreak around May 12, the number of face-to-face clinic visits decreased immediately, while the number of virtual clinic visits increased much later, with a 20-day delay. The Central Epidemic Command Center announced a level 3 pandemic alert from May 15 to July 27, 2021. NHI: National Health Insurance; NTUH: National Taiwan University Hospital.

Figure 3

The patient waiting times and physician visit times for video-based virtual clinics and face-to-face clinic visits. The median patient waiting time was 20 (IQR 9-42) minutes for face-to-face clinic visits and 3 (IQR 2-6) minutes for video-based virtual clinic visits (rank sum P<.001). The median physician visit time was 4 (IQR 2-9) minutes for face-to-face clinic visits and 3 (IQR 2-5) minutes for video-based virtual clinic visits (rank sum P<.001).