Telephone, video visits 'critical' for enabling safety-net care access
A study published this month in the Journal of the American Board of Family Medicine found that safety net providers in New York state reported positive experiences using telephone and video during the COVID-19 pandemic.
At the same time, researchers noted, "When it comes to equity in access, telemedicine presents a double-edged sword."
"On the one hand, telemedicine visits can make care more convenient and accessible by removing physical barriers such as distance or transportation costs. On the other hand, some telemedicine modalities, such as videoconferencing, entail using digital tools and technologies that may not be equally accessible to all patients," they continued.
"COVID-19 has further exposed dramatic inequities in technology access and utilization, compounding socioeconomic and racial disparities in health equity," they added.
WHY IT MATTERS
For the study, researchers analyzed visits to 36 community health centers in the state between February and November 2020, in addition to conducting interviews with 25 primary care, behavioral health and pediatric providers.
Perhaps unsurprisingly, they found that both video and phone visits increased significantly, peaking during the first wave of COVID-19 across New York. Between April 11 and May 2, more than 60% of visits were conducted via telemedicine.
"At every point following the stay-at-home orders, telephone visits accounted for a larger proportion of telemedicine visits than video visits, but the difference narrowed considerably over time," observed the researchers.
Virtual visits began to decline around the beginning of August. When it came to provider experiences, all the groups saw telehealth as being of similar quality to in-person visits. They also noted its success at reducing patient no-shows. The clinicians saw telehealth as particularly useful for certain populations.
"These included older adult populations, patients with comorbidities, frail or infirm patients, homebound patients with physical disabilities, patients with anxiety, pre-exposure prophylaxis patients that require relatively frequent visits, and patients undergoing opioid addiction treatment," the study said.
"Patients reliant on public transportation, patients with children, and patients with busy work schedules or jobs with less autonomy to leave during the workday were also cited as priority population groups for telemedicine," it continued.
However, pitfalls exist with these modalities as well.
"Certain types of care, such as play therapy, ongoing well-child annual visits, and vaccinations were not possible over telemedicine," observed researchers. "These limitations were amplified for certain patient populations."
Other limitations included difficulty with telemedicine integration with existing clinical workflow and increased caseloads.
Respondents also noted that video visits assisted with visual cues and some therapeutic methods, but also presented connectivity hurdles.
"For patients lacking the technology or access for video consultations or patients with lower levels of technical literacy, providers noted that audio-only visits represented the only viable option for a remote clinical consultation," read the study.
Clinicians pointed to three areas of potential improvement for telemedicine:
- Making platforms more user-friendly for patients and providers.
- Providing organizations with necessary financial assistance for implementing telehealth technology.
- Strengthening connectivity via WiFi enhancers and universal broadband access.
"While on-site clinical visits are crucial for patient care, both video and telephone visits will continue to shape how healthcare is delivered in a post-pandemic world," researchers said.
"Despite challenges, providers reported positive experiences delivering care remotely using both telephone and video during the COVID-19 pandemic and believe both modalities are critical for enabling access to care in the safety net," they concluded.
THE LARGER TREND
As more data becomes available about the uptick (and subsequent decline) in telehealth use during the pandemic, researchers have sought to understand more about its benefits and downsides.
For instance, a study published earlier this month found that in nursing homes, the rapid telehealth rollout reduced stress for residents and increased access to services, but also worsened social isolation and led to confusion among some patients.
ON THE RECORD
"When it came to communicating with patients, providers noted that telephone consultations might open conversation gaps due to an inability to read body language or facial expressions. Yet, for some visits, such as psychotherapy, not being seen may allow patients to speak more openly and with greater transparency," wrote researchers in the JABFM study.
"Future studies should explore how to support communication between patients and providers using different modalities. Other studies should also assess patient and provider preferences for the optimal type of modality and match these preferences to the most appropriate form of care delivery," they added.