Monday, March 30, 2020

Telehealth: improving connections or widening disparities?

- Jennifer Middleton, MD, MPH

Telehealth is taking off as family physicians strive to remain connected with patients during the COVID-19 pandemic. An AAFP News Brief this past week highlighted the experience of two family physicians as they transitioned the bulk of their outpatient care to telehealth. While telehealth shows promise as an efficient method of delivering effective care, it may also leave our patients with less comfort and/or access to its associated technologies behind.

One recent rapid review found that, overall, the quality of the care delivered via telehealth was equivalent to that of in-person care. Telemedicine peripherals, such as electronic stethoscopes, can be integrated into visits to provide clinical examination data. Telehealth can expand healthcare access to persons living in rural areas. This AFP AHRQ Effective Health Care Review regarding "The Effectiveness of Outpatient Telehealth Consultations" found that telehealth improved patient-oriented outcomes in mental health and wound care, while more limited quality evidence suggests possible patient satisfaction benefits and reduced health care costs.

Although many patients embrace virtual office visits, some are resistant. A 2014 systematic review found that nearly 1/3 of patients with chronic heart failure and/or COPD offered telehealth visits declined them; reasons cited included "[t]echnical problems, believing telehealth to be unnecessary, preference for in-person care, technology anxiety, difficulty remembering to interact with system, need for technical support, and finding telehealth to be a repetitive process." A 2018 study adds to this list "concerns over equipment or technology, concerns over service change, ease-of-use, knowledge of the benefits of telehealth, access to care, cost, and privacy." If these barriers are not overcome, a substantial minority of patients may miss out on the convenience and health benefits of virtual office visits.

This potential care gap has been minimized to date by telehealth's limited uptake, with only 15% of family physicians participating in telehealth in 2016. As more patients and physicians gain comfort with these platforms, though, it seems increasingly likely to persist once the pandemic is over. Eliminating health disparities is a core value of family medicine, and we will need innovative solutions to ensure that all of our patients who could benefit from telehealth can access it.

If you'd like to read more, this AAFP website provides in-depth information and resources regarding telehealth visits, and this recent FPM blog post reviews temporary rule changes regarding telehealth reimbursement.