For many family physicians, telehealth has become a common way of caring for patients during the COVID-19 pandemic, and this year's National Conference of Family Medicine Residents & Medical Students features several workshops that approach the issue in more detail.
Research published online June 26 in the Journal of the American Medical Informatics Association(academic.oup.com) focused on the implications of telehealth in addressing rural health disparities. It found that while telehealth has helped bridge communication gaps, allowed for the continuation of care and reduced patient and clinician exposure to the coronavirus, some longstanding barriers still must be addressed to improve the effectiveness of telehealth.
Opportunities and Challenges
The researchers analyzed the efforts of a rural hospital system in northern Michigan, where a statewide stay-at-home order was issued March 23. In response, the system implemented several telehealth measures, with more than 500 health care professionals in 75 ambulatory practices offering video and telephone visits. As a result, the system conducted more than 14,000 virtual visits in a six-week period, which provided patients with safe access to care while protecting clinicians and care teams from exposure.
- Caring for patients via telehealth has become more prevalent during the COVID-19 pandemic.
- A recent study examined the implications of telehealth services on rural health disparities.
- The study found that while telehealth has the potential to reduce many health disparities, ongoing barriers such as a lack of broadband internet access must be addressed.
Building on those accomplishments, the system has recently focused on using telehealth to screen and triage patients before they arrive at the hospital. According to the authors, telehealth is now being used to screen patients who present to the ER, while those with non-urgent complaints are asked to use their own smartphones or tablets to complete a virtual visit from their car or outside the hospital. In both instances, the objectives are the same: limiting exposure for patients and staff while reducing unnecessary use of personal protective equipment.
Other approaches include
- using telehealth in COVID-designated inpatient hospital rooms to improve communication between clinicians, support services and patient family members;
- allowing health care workers to work remotely to limit exposure;
- reintroducing students to hospital and ambulatory settings, which allows for virtual rounds and gives students opportunities to connect with patients without the need for PPE; and
- implementing telehealth services at long-term care sites, which reduces the need for patient travel and could decrease emergency department visits.
The biggest obstacle to providing high-quality telehealth services, the authors wrote, has been high-speed internet access. They pointed to FCC mapping data(www.fcc.gov) that showed while only 3% of residents in Michigan's urban areas do not have access to high-speed broadband internet, about 40% of people in the state's rural areas lack such access.
The authors suggested that the lack of broadband access in a time when social distancing is highly encouraged may have created additional health disparities for patients in rural areas. They cited research(journals.sagepub.com) showing that areas with limited broadband access also had higher rates of chronic diseases such as obesity and diabetes, resulting in "a double burden where those with the lowest connectivity have the highest need." They also suggested that limited access could prevent individuals from connecting online with family and friends, which could contribute to other adverse health outcomes.
To overcome this issue, the hospital system has started to offer visits via telephone instead of online. The system has also explored allowing patients to complete a virtual visit in their car from a designated location or at a clinic that has reliable internet access.
The authors wrote that while it's easy to see the potential that telehealth holds for addressing rural health disparities, solving the issue of limited broadband access must be a priority. Identifying other barriers to the use of telehealth and evaluating patient outcomes also are essential.
The authors also suggested that to ensure telehealth remains a viable option following the pandemic, rural health systems must develop a strategy that includes lobbying for continued third-party reimbursement of telehealth services -- something the Academy has actively advocated for months.
Finally, the authors called for more research to determine whether telehealth has produced any unintended consequences in relation to the pandemic. Such research would ensure that telehealth does not accidentally increase the health disparities of those who live in rural areas.
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