title: Who uses telehealth? Setting a usage baseline for the early identification of pandemic influenza activity.
abstract: OBJECTIVE
  To describe Ontario Telehealth usage for respiratory complaints during normal (i.e., interpandemic) circumstances.
  
  
  METHODS
  Descriptive analyses were conducted on symptom calls of a respiratory nature made to Ontario (Canada) Telehealth during a 25-month period.
  
  
  RESULTS
  Approximately 300,000 calls were made during the period under study, peaking annually in January/February. Calls were above average during the weekend and Mondays (p<0.0001). All-ages consultation rate was 0.21/1,000 (range, 0.11-0.43). Standardized call rates suggested an inverse relationship between age and call rate (except for >65 years of age). During peak activity, weekly telehealth call rates were up to more than twice the weekly mean and up to four times as high as the lowest weekly rate. Highest call rate was for under 5 years old (158.4/1,000). Male rates exceed female call rates in younger age groups; the pattern reversed in older age groups. The relationship between income and call pattern showed that income and call patterns were (1) directly related for under 5 years old, (2) inversely related for callers aged 45 years and above, and (3) bimodal (higher call rates in both the highest and lowest income groups) for callers 5-44 years old.
  
  
  CONCLUSIONS
  The advent of annual respiratory illness seasons under study here resulted in surge capacity. Data such as these can and should be used for exercises such as seasonal and pandemic forecasting. Also, recent pandemic experience has showed us monitoring both overall exceedances in usage and deviances from established demographic patterns could enhance existing routine surveillance.
authors.affiliation: Infectious Disease Epidemiology Unit, London School of Hygiene and Tropical Medicine, London, UK. erolland@gmail.com
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Rolland-Harris
authors.forename: Punam
authors.initials: P
authors.lastname: Mangtani
authors.forename: Kieran Michael
authors.initials: KM
authors.lastname: Moore
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D005260:Female; D014943:Global Health; D006801:Humans; D007251:Influenza, Human / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D008171:Lung Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D058873:Pandemics / Q000517:prevention & control*; D011159:Population Surveillance / Q000379:methods*; D011634:Public Health / Q000379:methods; D012017:Referral and Consultation; D012737:Sex Factors; D017216:Telemedicine / Q000706:statistics & numerical data*; D013997:Time Factors; D055815:Young Adult