Image from PYA
In the past few years, there has been a rise in telehealth, video visits with a remote clinician in particular. The use of virtual care is dependent on a person’s comfort meeting with their primary-care-provided (PCP) or a different provider via phone or video. Virtual care is an attractive option because it is more convenient and less costly than an in-person visit.
Some people are more open to telemedicine than others. A U.S nationwide survey conducted in 2015 found that respondents were more willing to see their own PCP via telemedicine, less willing to use telemedicine to see a different provider from the same healthcare organization, and least willing to use telemedicine to see a different provider from a different healthcare organization.
A study among patients with acute respiratory infection found that a telehealth visit was less expensive than an in-person visit, but increased collective health care spending because of convenience. Patients were more likely to initiate follow-up virtual visits if they had lingering questions about their diagnostic or symptoms. It seems like effective virtual care should aim to put people at ease.
Although virtual care is convenient and less costly, people of limited means may be less able to afford the technology (smart phone and data) needed to access virtual care. Further steps are needed to improve accessibility for people of limited means, in order to provide a wider range of people the option to decide what type of health care visit they want.
Image from Health eCareers
Can people get health advice via a video chat? It’s certainly more convenient. There is increasing utilization of these so-called “virtual care” evaluations. What might be missed compared to an in person visit? Will it be more or less satisfying for patients?
One study found that over two thirds of patients surveyed in an American Well survey reported satisfaction with a video visit — compared to one third that preferred office visits — and that most dissatisfaction stemmed from a technical issue with the video software that, if solved, led to positive reviews. One possible explanation for increased satisfaction from video visits is that it cuts down on transportation costs. The telemedicine system has been especially effective in the rural Appalachian region where many patients suffering from cardiovascular disease can now easily access a healthcare professional remotely rather than having to drive several hours to the closest health center. Additionally, remote consultations also allow increased patient independence and engagement, that is, they are more likely to participate in maintaining their own health to avoid in-person visits.
Post operative patients also benefit from telemedicine as an extended hospital stay may contribute to an increased risk of getting hospital-acquired infections. Instead, when they are sent home after a surgery, they are monitored by sensors that report patient vitals and other measures to health professionals remotely so they are still able to access help if something goes wrong. Telemedicine is still developing as a technology and may not serve as a complete replacement for office visits, but rather as a supplement to in-person consultations. However trends indicate that telemedicine is increasing in popularity across the country and chances are, you or someone you know may soon become familiar with telehealth.
Image from MobiHealth News
Telemedicine (the ability to get medical care by text, phone, or video chat) is increasingly combined with Direct-to-consumer (DTC) drug advertising. This seems to represent an attempt to increase sales of prescription medications by lowering the barriers and inconveniences of visiting a doctor. Many of the medications are for discretionary treatments. In some cases, the pitch includes a seeming medicalization of normal aging, such as the increased difficulty getting or sustaining erections and hair loss in men. It may also benefit pharmaceutical companies to suggest that normal aspects of human existence, such as performance anxiety, are conditions to be treated with a pill.
In DTC telemedicine, people complete an initial questionnaire that is reviewed by a clinician. Once select patients are notified over the phone or a video call, the prescription is either sent electronically to a local pharmacy or the medication is mailed directly to the patient’s home, often paid for out of pocket.
DTC telemedicine visits have several potential advantages over traditional clinic visits as a more standardized, efficient, convenient, and accessible model of care. The questionnaire can be structured to increase clinician efficiency. The increased efficiency and decreased overhead costs of an in-person clinic lower patient costs while increasing profit margins.
People may also benefit from the convenience of obtaining these medications without leaving their home, which may result in increased access to care for those in rural areas, patients without insurance, and those who feel uncomfortable talking about these sensitive health issues in person. An example of where this convenience might make sense is for prescribing and delivering birth control pills.
However, DTC telemedicine raises concerns about its effect on quality of care. The questionnaire is focused on screening for patients who don’t qualify to take the medication offered, rather than on finding the best possible treatment for a patient’s medical problem. The questionnaire may deemphasize the importance of healthier daily habits, accommodating the body’s changes, and working to improve mindset and circumstances for optimal health. In the guise of convenience, companies may be profiting from exploitation of individual vulnerabilities and insecurities, as well as the medicalization of aspects of a healthy human life.