How virtual service delivery has altered our healthcare systems and the ways people access healthcare, a clinical perspective
Healthcare systems have been dipping their toes into virtual service delivery over the past few decades, but with a worldwide pandemic on our hands, most of our systems were thrown into the deep end and virtual service delivery has become less of an option.
Virtual health care previously focused on providing services for a minority, who may need it due to their health, lack of transportation, or other factors which prohibited them from face to face contact, whereas now, virtual healthcare is necessary, acting as part of our global effort to combat COVID19. According to the Centre for Disease Control and Prevention (CDC), “recent policy changes during the COVID-19 pandemic have reduced barriers to telehealth access and have promoted the use of telehealth as a way to deliver acute, chronic, primary and specialty care”.
In the USA specifically, tele-medicine/tele-care has flourished during the pandemic largely as a result of policy changes particularly regarding reimbursement. In speaking with other healthcare professionals, there is a sense of both wanting to expand this, as well as a reality that this mode of service delivery does not work well for a large number of populations. For therapists working with portions of the paediatric population, individuals with significant physical disabilities, individuals with autistic, families with lack of access to smart devices and internet, and the list goes on, there is a lack of engagement that is increasingly seen when engaging through technology.
From personal experience, as an OT engaging with tele-health with a paediatric population mainly with significant physical disabilities and a large population of families who speak a different language than myself, the numerous barriers sometimes outweighed the therapeutic potential for progress. Tele-health was seamless for some families: mainly those with more cognitively neurotypical children and with very involved and available caregivers. However, other caregivers were, understandably, not able to balance working from home, co-ordinating e-learning or therapies for multiple children, whilst also playing the role of caregiver and therapy assistant. Add a language barrier or poor internet connection on top of that and we found that attendance for sessions quickly diminished.
However, “the health care community is faced with an unprecedented opportunity to learn from the current experience to draw lessons for the future, including the design of optimal systems of care that enhance access to and quality of care as well as contain cost, including patient-borne cost”. As stated here by Bashshur et. Al (2020), there is great opportunity as well as the continued challenges. There is a whole host of options opened in this world of virtual healthcare services. As shown in the table below, there are various types of telemedicine (as defined by the CDC). This means that those lacking transportation, those in remote areas, those who are immunocompromised, or simply those overwhelmed with all the duties of life were able to be seen by a provider without leaving their place of residence. There is a rise in availability of mental health providers, simple requests for your doctor, yearly check in with a specialist, continuity of care for a chronic condition, and on; all of which can add one layer of equity to our health care systems. All this said, this healthcare provider is both optimistic and cautious for the various segments of healthcare and what the advent of telehealth may be able to do to our systems.
Have you, or someone you know, used telehealth this past year?
What are some positives about that experience?
What are some challenges that you can imagine in the future as telehealth continues?
Can you imagine a scenario in which yourself or a loved one would opt to use telehealth? Or conversely, would want to be seen in person?
Types of telemedicine:
|Synchronous||This includes real-time telephone or live audio-video interaction typically with a patient using a smartphone, tablet, or computer.|
|Asynchronous||This includes “store and forward” technology where messages, images, or data are collected at one point in time and interpreted or responded to later. Patient portals can facilitate this type of communication between provider and patient through secure messaging.|
|Remote patient monitoring||This allows direct transmission of a patient’s clinical measurements from a distance (may or may not be in real time) to their healthcare provider.|
Centers for Disease Control and Prevention. 2020. Coronavirus Disease 2019 (COVID-19). [online] Available at: <https://www.cdc.gov/coronavirus/2019-ncov/hcp/telehealth.html>
Mary Ann Liebert, Inc., publishers. 2021. Telemedicine And The COVID-19 Pandemic, Lessons For The Future. [online] Available at: <http://doi.org/10.1089/tmj.2020.29040.rb>
McKinsey & Company. 2020. Virtual Health: A Look At The Next Frontier Of Care Delivery. [online] Available at: <https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/virtual-health-a-look-at-the-next-frontier-of-care-delivery>
Emily is currently practicing as an Occupational Therapist in central California and is a core member of Beyond Covid.