It’s difficult for patients to build relationships with their clinicians and be actively engaged in their care via telehealth, especially for our patient population. First, we have to remember or realize that for people with low socio-economic status, technology can be challenging, simply finding a private space to do a visit can be challenging, and there just may not be the same level of engagement because it’s not the traditional way of getting care.
It’s a little harder to adopt it readily. Second, people who are less resourced or who have been historically marginalized can find it difficult to speak up about what is bothering them or what they need. Trust and personal connection are absolutely critical and that is built with in-person care. Those are some of the pitfalls or barriers we work to address as we incorporate telehealth.
At the same time, it is convenient and can also be very effective – both from a cost and health outcome perspective. We definitely use it for patient convenience: if we don’t need to see them face-to-face, and if they have the ability to engage in a telehealth appointment, we do that.
Hardy: The pandemic accelerated the adoption of telehealth, and it’s a great tool for many types of primary care visits. It reduces the amount of time people have to take off for an appointment and alleviates transportation issues, which is the number one reason patients don’t show up for scheduled appointments at OLE Health.
It makes it more convenient for many to receive care or interact with a provider. It also offers providers additional flexibility and the opportunity to take advantage of remote work, which is a major plus for recruitment and retention of talent and employee morale.
However, we have found that many of our patients still want to see their provider face-to-face. And there are many services that cannot be accomplished via telehealth in the primary care realm – cancer screenings, dental cleanings and exams, and physicals.
On the behavioral health front, telehealth helps remove some of the stigma and shame or worry some patients may have that they will be judged for seeking help by someone they see or interact with. But, telehealth for behavioral health visits also has pitfalls as subtle nonverbals can be missed when you only see the patient from the shoulders up.
In terms of pitfalls more broadly, there are equity issues with telehealth, as many places still lack reliable broadband access. There are also concerns for patients who have low tech literacy.
Harris: Telehealth has the potential to support the democratization of healthcare, bridging the gaps between patients and communities lacking critical physician and provider resources to the broader medical expertise available across the industry.
The increased desire for virtual visits is also helping to drive changes in healthcare licensing practices that could allow providers to virtually and easily provide care across state lines, and as a result, lower the cost for both the patient and the physician.
This ‘shrinking’ and democratization of health care will be the catalyst for other healthcare innovations, as new market entrants drive the need for all health care delivery systems (local and further afield) to find new ways to conveniently meet the needs of our patients and elevate how our patients experience their care.
While telehealth is very effective and appropriate for many kinds of care needs, in some cases it is very important for patients and clinicians to form stronger relationships and trust that can be easier to do in person.
And some caregivers report feeling less connected with their patients when providing care only through virtual visits, and that can sometimes be less fulfilling and contribute to caregiver burnout. Another area of concern is the risk of leaving some socioeconomically disadvantaged and vulnerable communities behind due to the “digital divide.”
Hennelly: From a healthcare provider’s viewpoint, the ability to provide care via telehealth will enable us to provide more expedient care. Patients won’t have to dedicate hours to drive to see a provider, they’ll simply need 15 minutes on a screen. That means no need to take time off work, or find someone to drive them to the appointment, or needing to cancel due to other factors.
Many barriers simply disappear.
We do have some significant hurdles to address. Access to technology and comfort using it is significant, especially with seniors. We continue to be the great ‘melting pot,’ and language is a barrier. Our care teams don’t always mirror our communities.
There is also great value in face-to-face interactions. In a clinical care setting, a patient interacts with numerous people, each of whom has the potential to uncover relevant information that can assist in the provision of care. With telehealth, many of those interactions don’t happen. Everyone will need to adapt as the care delivery model evolves.