The following is a condensed version of an upcoming news article by Joan Zolot scheduled for AJN’s May edition.
Studies of safety and quality will determine the optimum use of this option.
Photo by Anna Shvets from Pexels
The use of telemedicine surged during the COVID-19 pandemic. Phone and videoconferencing limited patients’ exposure to the virus while maintaining their access to care. One estimate found that virtual care peaked at 42% of all ambulatory visits covered by commercial insurers in April 2020. The February 2 JAMA published several articles* addressing the safety, effectiveness, and quality of virtual consults and their future in health care.
Some obvious and potential benefits.
Because of its efficiency, virtual care has been shown to be particularly suitable for mental health consults, prescription refills, and straightforward evaluations. It can reduce patient inconveniences such as travel to appointments and lost work time. It can also enable patients to receive needed care sooner, especially those with limited mobility, caregiving responsibilities, or who live in remote areas. It may also have the potential to improve care coordination by enabling primary care clinicians and specialists to confer jointly with patients.
Risks, concerns, ongoing questions.
Because virtual medicine does not allow for physical examination, it’s inadequate for common clinical situations such as diagnosing a child with ear pain and could lead to delayed diagnoses or misdiagnoses. It could also undermine preventative screenings. Blood pressure assessments, for example, dropped 37% from April through June 2020 compared to the same period in 2018 and 2019. It’s speculated as well that virtual care might end up costing more if clinicians order more tests to compensate for the lack of physical examinations.
And virtual care could increase disparities in health care access and quality because of uneven Internet or cell phone service in rural areas and among older or low-income Americans. In a study of California outpatient health centers providing care to 30 million low-income individuals cited by Uscher-Pines and colleagues, 48.5% of patient visits from March to August 2020 were by telephone, compared with 3.4% by video, and 48.1% in person. The absence of visual cues when clinicians and patients talk by phone but cannot see each other might also result in lesser-quality care.
In addition, human connection, which can be so integral to clinician–patient interactions, might be reduced by virtual health care.
Considering the future of telehealth.
Research assessing the quality and accessibility of virtual care is underway and clinical practice guidelines should follow. Among many questions are when and under what conditions should clinicians pivot from virtual to in-person care. Emerging, web-based medical technology such as mobile apps and wearable devices will further challenge researchers and clinicians to define best practices for virtual medical care.
PA, Herzer KR, Pronovost PA. JAMA 2021;325(5): 429-30
Mehrotra A, et al. JAMA 2021;325(5): 431-2
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