Telehealth and Access to Care
How telehealth has impacted health care delivery today
The popularity of telehealth has vastly increased since the beginning of the COVID-19 pandemic. Telehealth can take on many forms, including phone calls from medical team members, video conferences, mobile health applications, and online discussion groups, to name a few. This healthcare delivery mode has been impactful in rural areas where immediate access to medical personnel may be more complicated than those living in larger cities. COVID-19 brought uncertainty to mind. Therefore, a shift appeared in ways of providing telehealth that could slow the burden of the pandemic on the already-overwhelmed healthcare system. In the first quarter of 2020 alone, telehealth visits increased by 50% compared to quarter one, 2019.
What are the advantages of telehealth? What are the barriers to telehealth?
Telehealth tackles several barriers for various groups. For one, it is cost-effective, as a trip to the provider's office costs time and money. Second, telehealth has allowed for continuity of care for patients who struggle to make numerous in-person provider appointments. Third, telehealth allows for social distancing, which helped slow the spread of the virus. This was critical in the first few months of the pandemic when many hospital systems could not provide care to everyone in need of medical attention. Fourth, telehealth has allowed more triaging and screening of patients. It allowed identifying those who need to be seen by a provider and patients who may be better served by nurse visit or other healthcare personnel.
While telehealth is an excellent tool for delivering health care in specific settings, it comes with drawbacks also. For example, providers and patients who are not tech-savvy or have never used telehealth are now faced with learning a new system. Internet access is not always affordable or available for consumers. Patients living with loved ones may not always have a private space in the home to participate in a telehealth visit. Telehealth does not allow for performing in-depth physical examinations. Using electronic health information across providers of varying healthcare systems could, at times, stall the progress of providing patient care.
To manage some of these barriers, some providers have expanded office hours. The change allowed more options for patients to meet with the provider and for the provider to spend more time developing a comprehensive care plan based on a patient's needs.
Although telehealth was initially intended to bridge the gap between providers and those living in rural areas, the pandemic taught us this service is needed for patients across various populations. A recent study showed telehealth visits were used in several categories worldwide, including follow-up visits, training, consultations, medications, communication, and caregiver support. Some studies describe telehealth's impact on chronic disease management and emergency department visits. They are limited. However, researchers believe telehealth may be beneficial in the long run.
Telehealth beyond the pandemic
Providers and health systems will need to develop a standardized process to allow patients to transition from in-person to telehealth visits as necessary. For example, suppose the method used for telehealth requires any computer download or a specific operating system type. In that case, this should be explained in advance. Additionally, providers and health systems will need to determine how cost-effective a telehealth system is.
For example, does the use of telehealth decrease patient no-shows? Or increase medication adherence? Did the population served have access to the internet during regular business hours? How can we show patients seeing a provider by electronic means that they are getting the same or adequate care? These are essential points to consider as telehealth continues to become more routine in various settings.
Here are five factors to consider for patients and providers using telehealth.
1. Internet accessibility and a quiet location are needed for telehealth. If you are concerned about connectivity issues, consider sticking to in-person visits.
2. Charge the device you plan to use before your visit.
3. Choose a spot with plenty of light so others can see you on the call. (Also, consider the background you want to use).
4. Providers and patients alike may run behind when getting to a scheduled appointment. Allow extra time for the visit in case your visit starts early or late.
5. Patients should be offered an online “waiting room.” This may encourage patients to join a few minutes early, allowing them time to work on any connectivity issues and feel like they’re still experiencing a provider’s visit.
References
Bitar, H., & Alismail, S. (2021). The role of eHealth, telehealth, and telemedicine for chronic disease patients during COVID-19 pandemic: a rapid systematic review. Digital health, 7, 20552076211009396.
Dhaliwal, J. K., Hall, T. D., LaRue, J. L., Maynard, S. E., Pierre, P. E., & Bransby, K. A. (2022). Expansion of telehealth in primary care during the COVID-19 pandemic: benefits and barriers. Journal of the American Association of Nurse Practitioners, 34(2), 224-229.
Gajarawala, S. N., & Pelkowski, J. N. (2021). Telehealth benefits and barriers. The Journal for Nurse Practitioners, 17(2), 218-221.
Koonin, L. M., Hoots, B., Tsang, C. A., Leroy, Z., Farris, K., Jolly, B., ... & Harris, A. M. (2020). Trends in the use of telehealth during the emergence of the COVID-19 pandemic—United States, January–March 2020. Morbidity and Mortality Weekly Report, 69(43), 1595.
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