Telehealth use has surged as a result of the COVID-19 pandemic. In a study of 36.5 million individuals in the United States, which was published recently in JAMA Network Open, investigators at Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, found that in-person ambulatory medical contacts decreased by 18% during March to June 2020 compared with the same period in 2019. Telehealth use increased from 0.3% of all medical encounters in 2019 to 23.6% of all encounters in 2020. Individuals aged 18 to 49 years and those with more than 2 chronic conditions used telehealth the most. Overall total medical care costs, including hospitalizations, dropped 15%, from $358 to $306 per person per month, from 2019 to 2020.
The shift to telehealth occurred as many medical practices halted or curtailed in-person office hours and patients stayed away from physicians’ offices out of fear of transmission during the early months of the pandemic. At the same time, insurance companies and the federal government relaxed policies around telehealth to meet demand for remote medical consults via internet video or telephone.
Recent survey findings presented at the Endocrine Society’s 2021 annual meeting showed that two-thirds of patients with chronic endocrine problems who need close monitoring say they would like to continue with telemedicine follow-up visits after the COVID-19 pandemic ends. The survey included 109 patients, with 65% of respondents saying they would like to continue with telemedicine after pandemic. The survey also showed that 42% of patients prefer video visits and 37% prefer phone calls.
Lead researcher Maryam Nemati, MD, of San Joaquin General Hospital in French Camp, California, who presented the study findings, said endocrinology clinics have significant numbers of patients who need long-term close follow-up for medication adjustments, symptom checks, and counseling.
“Recent progress in telemedicine and incorporating technologies such as Zoom make remote visits a lot easier,” Dr Nemati said. “In the past year, because of the pandemic many patients tended toward remote visits. This experience showed most patients felt that their concerns were addressed via telemedicine and quality of tele[medicine] visits both via video and phone were like in-person visits. Telemedicine is less expensive and timesaving.”
Dr Nemati and her collaborators conducted the survey from January to May 2020. They asked patients and providers about the benefits and limitations of telehealth visits compared with in-person visits. The investigators analyzed the patient no-show rate for 6 weeks before and after telehealth visits. Results showed that 65% said they would like to continue with telemedicine after the pandemic and 77% stated the quality of care with telehealth, both by video and phone, are almost the same as an in-person visit.
Among providers, 75% wanted to continue with telehealth after the pandemic, and 50% reported patient satisfaction as a benefit of telemedicine. The survey revealed that 60% of providers believed lack of physical examination is a limitation of phone visit, and 87% of the providers believe the quality of care is better with in-person visits than phone visits. The no-show rate decreased from 30% to 27% after the implementation of telehealth visits.
“Popularity of telemedicine is growing fast. Telemedicine for chronic diseases may help with patients’ compliance by decreasing various burdens including taking time off from work, driving to appointments, and waiting to be seen. Telemedicine may help clinics reduce cost by seeing more patients with less staff,” Dr Nemati said.
Michelle Griffith, MD, associate professor of medicine and medical director of Telehealth Ambulatory Services at Vanderbilt University in Nashville, Tennessee, said many types of care can be provided by telehealth, and using telehealth does not have to be all or nothing.
“For many patients who are seen multiple times per year, a mix of in-person and telehealth visits may be most appropriate,” Dr Griffith told Renal & Urology News. We have seen sustained uptake in specialties that care for chronic conditions and expect we will see continued growth there.”
Genitourinary oncologist Nancy B. Davis, MD, associate professor of medicine at Vanderbilt, said given the frequently immunocompromised status of cancer patients, it was vital to have telehealth as an option to continue their care without interruption.
“Telehealth was very well received by patients, older and younger,” Dr Davis said. “Cancer patients and their cancer care teams develop strong bonds, as we are in the fight together. The pandemic decreased our ability to see our families, friends and, for our patients, their cancer teams. Telehealth was an excellent way for the patients to see their teams and know that we were still there, right alongside them.”
Telehealth has been available for years, but uptake until the pandemic was minimal primarily due to lack of reimbursement for these visits by Medicare and private insurance companies. Additionally, patients needed either a smartphone or a computer. “I am optimistic telehealth is here to stay, as it was shown to be feasible and well received by both providers and patients,” Dr Davis said. “One of the biggest hurdles is that of interstate licensing. As by law, I would need to be licensed in the state in which my patient is residing or taking the telehealth visit. The AMA and other medical societies are working on this, and currently there is the option for Interstate Compact Licensing, which facilitates the ability to become licensed in a state other than that of our primary practice site.”
Weiner J, Bandeian S, Hatef E, et al. In-person and telehealth ambulatory contacts and costs in a large U.S. insured cohort before and during the COVID-19 pandemic: Implications for the future of virtual care. Published online March 1, 2021. JAMA Netw Open. 2021; 4(3):e212618. doi:10.1001/jamanetworkopen.2021.2618
Nemati M, Reddy A, Jung S, et al. Evaluating the use of telemedicine in endocrinology clinic. Presented at ENDO 2021, the Endocrine Society’s annual meeting; March 20-23, 2021. Abstract P22-25.