University of Lynchburg DMSc Doctoral Project Assignment Repository

University of Lynchburg DMSc Doctoral Project Assignment Repository




Dr. Larry Herman, DMSc, MPA, PA-C



Purpose: To evaluate the benefits of using physician assistants or nurse practitioners in assisted synchronous otorhinolaryngology (ENT) telemedicine models for areas typically underserved by surgical subspecialties, utilizing lessons learned before, during, and after the initial and subsequent COVID-19 pandemic.

Method: A systematic retrospective review of PubMed, Cochrane, Medline, Google Scholar, and CINHAL of ENT telemedicine over the last 22 years was conducted to identify pre and post COVID-19 studies covering the search terms related to COVID-19, ENT APs and their direct and indirect effects on technological, governmental changes, telemedicine standards of care, or best practices. Incorporating the utilization of advanced practitioners (AP) such as physician assistants (PA) and nurse practitioners (NP) in assisted synchronous models of care and cost minimization or description of cost-benefit for telemedicine was a primary factor for this study review.

Results: From the original 102 studies reviewed, only 22 were relevant and had at least three of the five terms in the search criteria. Four governmental regulatory and statutory changes were referenced regarding COVID-19. The quality of studies was generally found to be lower, and only two determined costs directly attributed to utilizing APs in assisted synchronous models. Models using assisted synchronous models have demonstrated better diagnosis accuracy concordance and patient approval when compared to both asynchronous telemedicine or when using non-provider assistance such as a medical assistant to perform exams for a remote ENT physician. Recent studies since 20181,3-5 that have reviewed medical technology modernization have found a significant improvement in both examination, portability, and pixelation quality, leading to better diagnostic and diagnosis accuracy, therefore improving on previous limitations.

Conclusion: Otorhinolaryngology PAs have the potential to bridge the disparate health care access for ENT. The ENT PA can perform standard ENT assessments and diagnostic examinations. When supported by the recent advancements in technology, they are enabled to remotely collaborate with ENT physicians by utilizing assisted synchronous telemedicine models to manage and assess complex cases or when beyond the ENT PAs scope. This collaboration and ability for instant reach-back allow APs to remotely capture potential patients so they can be managed or triaged to ENT physicians for definitive care and surgery if needed. The benefits will include the potential to increase patient access, create additional revenue sources, improve diagnostic and diagnosis accuracy with overall high patient satisfaction.


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