Telehealth, no more than a pipe dream in medical circles not so long ago, is inching closer to becoming mainstream as a means of providing medical care to patients. That's why the AAFP routinely jumps into policy discussions on the issue, and why the AAFP Board of Directors adopted an official policy on the topic in July 2016.
Member interest in telehealth was strong enough to establish the Telehealth Member Interest Group way back in December 2014.
Yet for all the interest in this area, researchers at Emory University School of Medicine in Atlanta and the Washington, D.C.-based Robert Graham Center for Policy Studies in Family Medicine and Primary Care(www.graham-center.org) discovered a giant hole regarding information on the adoption of telehealth services among family medicine residency programs. Their research is detailed in an article, "Over Half of Family Medicine Residency Program Directors Report Use of Telehealth Services,"(www.liebertpub.com) published online Oct. 4, 2019, in Telemedicine and e-Health.
Why is that knowledge gap important?
Co-authors Anuradha Jetty, M.P.H., a Graham Center research associate, and Megan Coffman, M.S., administrator of the Graham Center's health policy research, provided some insight for AAFP News. Corresponding author Miranda Moore, Ph.D., an assistant professor in the Department of Family and Preventive Medicine at Emory, was unavailable for comment.
- Family medicine residency program directors responded to a series of survey questions about their programs' use of telehealth services.
- Based on survey responses, researchers concluded that although family medicine residency programs use telehealth services, many do so infrequently and in a limited fashion.
- Specifically, 57.5% of respondents said their residents used telehealth services in 2015, and 29% provided live interactive video visits.
"Family physicians have identified lack of training on how to use telehealth as a barrier to providing telehealth services," Coffman said. "If family physicians are not provided opportunities to deliver telehealth in residency, it may prevent them from offering telehealth services to their patients once in practice."
After analyzing survey data, authors concluded that a majority of family medicine residency programs use telehealth services -- albeit infrequently and in a limited fashion.
For purposes of their research, the authors defined telehealth as "the use of medical information exchanged from one location to another via electronic communications to improve a patient's health."
Telehealth primary care services involve a primary care physician consulting with a subspecialist through the use of live interactive video.
The authors defined e-visits as an "asynchronous electronic visit" with a doctor through email, patient portals or an online form and/or as store-and-forward services that include the sharing of diagnostic images, vital signs or patient data between the physician and a subspecialist who is not in the same location as the patient.
Researchers used the 2015 Council of Academic Family Medicine Educational Research Alliance Program Directors Fall Survey to communicate with 461 family medicine program directors in December 2015 and January 2016. A series of questions on telehealth was developed by the Graham Center and included in that survey. A total of 207 surveys returned were eligible for analysis, a 44.9% response rate.
Program directors were asked about the kinds of telehealth services their programs were capable of providing and whether their facility served as the originating site and/or the distant site for provision of primary care services and subspecialist referral services.
The directors also were asked how often residents had used live interactive video, e-visits or store-and-forward technology in the past 12 months to deliver primary care services, as well as primary care and subspecialist referral services.
Lastly, directors were asked about the clinical purpose of use and the approximate number of patients that residents cared for using the technology.
Researchers reported that 57.5% of program directors who responded to the telehealth questions on the survey said their residents used telehealth services in 2015.
Additionally, responses showed that
- 70.6% of programs provided only e-visits or store-and-forward services,
- 29% provided visits using live interactive video,
- 19% provided both live interactive video visits and other e-visits or store-and-forward services,
- 11% provided only live interactive video visits, and
- 63% of the programs that used live interactive video served as the originating site for the delivery of primary care services.
Importantly, 46% of respondents said their residents "never delivered primary care services using live interactive video." Furthermore, the mean number of patients who received care via live interactive video was just 29 patients.
Survey results also showed that 44% of programs used e-visits or store-and-forward services on a daily or weekly basis; 56% of programs used the services for follow-up, 49% used them for chronic disease management, and 48% used them for diagnosis and treatment.
The authors suggested that patient demand for better access to health care services would drive growth in providing telehealth and said that new physicians need opportunities to explore technological tools during residency training.
"Given the provision of telehealth services may require skills that are not necessary for face-to-face encounters -- such as technological skills and skills 'presenting' to a camera -- family medicine residency programs using telehealth services would be well served to offer at least basic training on telehealth service delivery to their residents," wrote the authors.
Researchers also pointed to survey data on programs' limited use of live interactive video and identified that finding as one barrier to the wider adoption of such services.
"Family medicine residency program investment in live interactive video services is important to ensure that residents are offered opportunities to use telehealth services," they wrote.
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