COVID-19-related knowledge, health behaviors and attitudes towards telemedicine and emergency visits in a population of kidney transplant (KTX) recipients

Purpose: We explored knowledge about COVID-19 and attitudes towards emergency care and telemedicine visits in a population of inner-city KTx pts. Methods: A telephone survey was administered to a random sample of 33 KTx pts during July 2020, including questions regarding knowledge about COVID-19, health behaviors and attitudes regarding emergency and telemedicine visits. A COVID-19 knowledge score and COVID-19 concern score were calculated, with higher numbers indicating better knowledge and higher concern. Results: Mean age was 58.3±11.1 yrs, with 19 (58%) men and 14 (42%) women with 23 (74%) Black, 4 (13%) Hispanic, 2 (7%) White, and 2 (7%) Other. 25 (78%) pts had not completed college. Five (15%) pts answered all questions correctly on COVID-19 knowledge, 28 (85%) answered at least 1 question incorrectly. 23 (74%) pts were afraid of COVID-19. 15 (46%) pts feared going to public places. 32 (97%) believed social distancing is important. Half were afraid of getting infected from a friend (18, 55%) or a family member (17, 52%). 27 (93%) reported feeling unsafe traveling on a plane. 6 (21%) pts reported reluctance to go to the ED if they had a medical emergency, including if they had a persistent low-grade fever (8, 28%), trouble breathing (2, 7%), or extreme belly pain (5, 17%). Pts who were afraid of going to the ED had higher scores for fear of COVID-19, fear of getting infection from a family member, fear of going to public places, and fear of traveling on an airplane (p<0.05). No associations were found between concerns about ED and COVID-19 knowledge. Pts who preferred telemedicine over in-person appointments were less likely to go the ED in an emergency (40% vs 89%, p<0.05) and scored higher overall on the COVID-19 knowledge (0.90±0.12 vs 0.76±0.13, p<0.05). No association was found for telemedicine preference and attitudes towards COVID-19. 100% (31) of pts reported: hand-washing with soap and water;using masks in crowds;and isolating if flu-like symptoms were felt. Fewer avoided touching eyes, nose or mouth (94%);sanitized regularly surfaces at home (90%);avoided traveling for fun (87%), leaving their home (61%), or interacting in-person with someone who has COVID-19 (87%). No associations were found between behaviors and COVID-19 knowledge, telemedicine preference, or ED concerns. Conclusions: In our population of KTx: 1. The majority of pts are knowledgeable but concerned about COVID-19 and follow public health guidelines. 2. Few pts answered all knowledge questions correctly. 3. Over a quarter would refuse to go to the ED if they had a persistent fever and many were concerned about the ED in general. 4. Pts who preferred telemedicine appointments were more knowledgeable about COVID-19 and less likely to go to the ED which may reflect their overall concern with COVID-19 exposure. 5. Education of our patients regarding actual risks of in-person or ED visits should be done to assure that they get care when needed.