TeleHealth
Sonya Collins
The technology to provide health care remotely via phone or video has existed for years. The only thing missing was demand. Then, in early 2020, as COVID-19 swept the nation, many physicians’ offices suddenly closed while others sat empty amid patients’ fears of venturing out for routine or preventive care. Suddenly, telehealth wasn’t simply an occasional, optional convenience; it was a necessity.
Today, as life slowly returns to normal, people have suspended many of their virtual activities and taken their lives back into the real world. But telehealth appears to be here to stay, which may point to an underutilized area for exploration in community and health-system pharmacy.
“Telehealth is definitely an untapped market where pharmacists could optimize patient care,” said Melissa Badowski, PharmD, a clinical associate professor of pharmacy practice at University of Illinois Chicago College of Pharmacy. “The more contact you have with a patient—assuming that’s what they want—the more they buy into their health care and the better their outcomes are going to be.” Badowski provides disease state management via video visits to incarcerated people living with HIV.
Telehealth use sky-high in last two years
By the second quarter of 2020, Teladoc, a leading provider of telehealth services in the United States, had seen a more than 200% increase in virtual visits over the previous year, according to Fierce Healthcare, a health care management news service for health care industry executives. Much of the spike in demand results from high COVID-19 rates. But that doesn’t mean telehealth visits will plummet along with falling COVID-19 infection rates.
Data show that even in times and places where caseloads have been low and normal activities have resumed, virtual visits have held steady at rates significantly higher than those during the same quarter in the year prior to the pandemic.
Another indicator of future outlook for telehealth is found in the reasons behind telehealth visits. While COVID-19 drove demand for the format, it was not the reason patients sought physician visits. A 2020 study in the Journal of Medical Internet Research found that behavioral health and chronic conditions were the main drivers of telehealth visits with Doctor on Demand, Inc., from February to June 2020.
Chronic conditions, complex patients may benefit most
Telehealth can take place by telephone or video chat. With patients who have internet access and facility with the technology, Badowski prefers video as it allows her to see and hear her patients.
“It’s a lot easier to pick up on those nonverbal cues. I’ve had patients on video who have tears in their eyes,” she said.
Telephone consultations, on the other hand, increase access for patients who might consider video conferencing a barrier. “Most people have a phone, but not everyone has the data that allows them to connect to a video visit.”
Ultimately, the optimum format depends on the patient. “You have to really look at your patient,” Badowski said. “It’s not whether telehealth is something I want to offer. It’s about what kind of access the patient has.”
Management of chronic conditions is one of several key areas where pharmacists can play a major role in virtual provision of health care services.
“Anyone with a chronic disease state, no matter what it is, could benefit from telehealth,” Badowski said. “Also, anyone who’s taking more than a certain number of medications—over 7 usually increases risk for drug interactions, especially in older adults—would benefit, too.”
Numerous studies confirm that telehealth is effective for medication management, chronic disease management, and improving medication adherence in diabetes, hypertension, depression, and cardiovascular disease.
In at least one respect, Badowski finds telehealth superior to an in-person visit. The virtual format allows her to meet one-on-one with each and every patient the physician sees.
“If you are in a busy pharmacy setting or in an office with multiple providers, that’s not going to happen,” she said. “I get to educate every single person about their medications, antiretrovirals, possible interactions, and any new medications they’re started on.”
Transitions of care is another area that offers opportunities for telehealth. Visiting patients in their home via video allows pharmacists to see all of the patient’s medication and communicate with caregivers, too.
Social determinants of health, Badowski points out, may also be an indication of who might benefit from telehealth. Patients who lack reliable transportation and therefore wouldn’t appear in person for a comprehensive medication review, for example, also stand to benefit greatly from telehealth services.
“It bridges the gap between provider appointments with a check-in in the middle of that timeframe.” ■