LAUSR

Utilization of telemedicine during the COVID-19 pandemic has allowed increased access to care while limiting in-person visits and risks of viral transmission [1]. The American Society for Reproductive Medicine and European Society of Human Reproduction and Embryology recommended limiting in-person consults and instead using telemedicine at the start of the pandemic, and telemedicine continues to be widely used even as guidelines have allowed for more inperson appointments at infertility centers [2, 3]. Prior to the pandemic, telemedicine options were found to reduce barriers to healthcare access, particularly for patients who live farther away from clinics, with high patient satisfaction and, importantly, without affecting treatment outcomes [4, 5]. There are also economic benefits for patients of less travel time and time off work. However, prior to the pandemic, telemedicine consultations were reimbursed at lower rates than in-office visits, rendering it challenging for healthcare organizations to provide it as a viable alternative. In midMarch 2020, the US Medicare program expanded coverage to telephone and videoconference visits for all patients, a change that was largely followed by other insurers [6]. Given this recent paradigm shift as a result of COVID-19, we sought to ascertain patients’ perceptions of telemedicine modalities and their preferences for future infertility consultations. All patients who attended a large, university-affiliated infertility practice in New England, USA, between January 1, 2019, and April 1, 2020, were included. The initial questionnaire was distributed to eligible patients from April 9 to 16, 2020. The study was determined to be exempt from review by the Institutional Review Board at Beth Israel Deaconess Medical Center (2020P000322). We received 3604 complete responses (response rate 34%) [7] via REDCapTM [8], a secure, HIPAA-compliant web application for online surveys. Using this platform, we linked consecutive questionnaires from the same individual, while maintaining anonymity. The same cohort of patients who initially responded received another questionnaire on January 1, 2021, with 1855 complete responses (51% response rate). Analysis was restricted to patients who were not pregnant and actively pursuing infertility treatment (n = 1119). We used chi-square or Fisher’s exact test to compare categorical variables. Paired data was compared using a paired t-test for continuous variables and McNemar’s test for categorical variables. For all tests, p < 0.05 was considered statistically significant. All analyses were performed in SAS 9.4 (SAS Institute, Cary, North Carolina). The majority of respondents self-identified as non-Hispanic White were married or in a domestic partnership, had completed college, and were employed. In April 2020, just before the peak of the first pandemic surge in the New England area, the majority of respondents selected “in person” as their preferred consult modality (58.1%), but by January 2021, the top preference shifted to “video telemedicine” (53.4%, p < 0.001) (Table 1). Overall, in January 2021, respondents’ top preference for modality of future consults was to have a combination of telemedicine and in-person consults (combined modalities with majority via telemedicine video/telephone (42.3%) or combined modalities with majority in person (32.1%)). A secondary analysis demonstrated that age, race/ethnicity, completion of college, and household income were factors significantly associated with patient preference for consult modality (all p < 0.05). Non-Hispanic White respondents Denis A. Vaughan and Sophia H. Yin contributed equally to this work.