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Pros and Cons of Telehealth in Primary Care

The COVID-19 pandemic prompted healthcare systems to create new care delivery modules using more telemedicine and an integrated team approach. Telehealth helps gather data from patients at home, enabling preventive care and reducing admissions, thereby cutting costs and freeing up beds for patients in need of acute care.

Telehealth is shaping the future of healthcare in two major areas: increasing access to care coverage in rural communities and improving mental health services. Better monitoring and effective communication can improve quality of life, reduce admission and improve outcomes.

Like everything else, however, telehealth in primary care has both pros and cons.

Highlighting Overall Pros and Cons

Pros. Telehealth can improve access and timeliness of care, identify problems earlier and cut out-of-pocket patient costs. It can reduce barriers to care for patients who have transportation or mobility issues or live far from healthcare facilities or specialists. Wearables give patients more personal control and partnership in their healthcare. Patient portals, such as MyHealth, improve patient/care team communication for a timelier response to refills, tests or medical questions.

Cons. Telehealth barriers can include licensure, reimbursement, legal, confidentiality and geographical issues. Of course, not all visits can be virtual such as comprehensive physical exams requiring palpation or auscultation, biopsies or imaging. No electronic system is 100% secure, but vigilant cybersecurity measures can help offset the risks. A patient’s lack of familiarity with electronic health record systems, an inability to troubleshoot technical difficulties and unreliable connections often pose challenges. In addition, immediate access to electronic health information may allow patients to learn about a diagnosis through their patient portal instead of their provider.

Reaching Residents in Sparsely Populated Areas

For many living in rural America, sometimes the region where they work, live and play does not have close access to a healthcare provider or specialists. Telehealth helps expand the reach of providers in rural areas. Care teams can develop comprehensive plans using local resources and telehealth services for optimal, well-coordinated patient care.

John is a 59-year-old rural Nebraska farmer who felt palpitations in his chest and some swelling in his feet. Testing reveals that he needs a new heart valve after a referral to the closest cardiologist. Wearables allow his primary care and cardiology teams to monitor him before and after surgery. Every morning, his weight, blood pressure, blood oxygen levels and heart rhythm transmit from a wearable or through the portal where both the cardiologist and primary care offices can see the information.

Telehealth allows expert consultation for both the patient and the local care team. For example, in the scenario above, if a cardiologist or cardiac surgeon needs mentoring or education then a remote consult allows the patient to receive the best medical care closer to home. 

Improving Mental Health

Primary care providers are leading integrated mental health services. Virtual care mental health services offer many benefits including convenience and comfort. Patients, couples and families often feel more comfortable with online video therapy or telepsychiatry services. Group telehealth offers a sense of community, reduction of isolation and new perspectives. In addition, telehealth can be part of an integrated approach for substance use disorder.

Janice is a 26-year-old who works remotely for a banking call center. Her primary interaction is with her dog due to living alone and working from home. She reports a sad mood and low energy and admits depression and not wanting to engage in social activity. Her primary care provider is comfortable prescribing her an antidepressant if she agrees to therapy. With mental health services, Janice starts purposefully planning bi-monthly social activities.

Mental health services may be provided by the patient’s insurance, but cash pay options cost significantly less for virtual visits.

Moving Telehealth Into the Mainstream

Efforts are ongoing to help providers, practices, and health systems through a Telehealth Immersion Program. Patients need comprehensive services with an online provider, prescriptions, urgent care, therapy and mental health through high-quality, convenient appointments via video chat. Most major carriers cover services with affordable cash pay options available.

Best practices for telehealth systems include provider availability at short notice with coverage for late evenings and weekends and collaboration with a 24-hour pharmacy. Some services ship equipment or testing directly to the patient with instructions for use.   

Telehealth provides a path to improving healthcare that aligns with the National Academy of Medicine plan of the Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. Telemedicine will be one of the dominant features to reach this goal. All patients should have equal access to telemedicine — not just those who can afford smartphones, internet or insurance. Healthcare professionals and systems have a crucial role in assessing for “digital poverty” and low digital health literacy so that they can take the appropriate measures to achieve health equity.

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