Contending that the COVID-19 pandemic forced medicine to evolve by accelerating the use of telehealth, a speaker said it is critical to consider the future role of virtual care and how the best clinical outcomes can be achieved.
“COVID-19 has changed the way we view medicine and we’re not going to go back,” Martin Schreiber, MD, chief medical officer for DaVita Kidney Care’s home modalities, said during his virtual presentation at the Annual Dialysis Conference. “We just have to get better at providing telemedicine. Everyone that is part of the health care team needs to get better at it.”
To illustrate the profound impact COVID-19 has had on the use of telehealth, Schreiber noted that prior to the pandemic less than 40% of patients with a chronic condition had a telehealth visit; since the pandemic, this number rose to more than 60%. In addition, compared with the general population, patients with a chronic illness have expressed greater support of telemedicine, with 53% stating that telemedicine provides the same or better quality of care as an in-person visit (vs. 28% of the general population). Schreiber attributes this to the increased frequency of appointments for those chronic conditions.
Further, according to a paper published by the American Society of Nephrology’s COVID-19 Home Dialysis Subcommittee, patients view telemedicine positively, as it is more convenient, leads to cost-savings (eg, transportation costs) and lowers the risk for acquiring COVID-19.
“I believe face-to-face is still the best approach, but like anything else we have to realize that getting chronic care is not easy for patients,” Schreiber said. “And it’s not easy to get public transportation or to pay for gas. So how do we make care both excellent and comprehensive but, at the same time, more efficient and convenient for the patient?”
Schreiber addressed some barriers and challenges that must be dealt with moving forward if use of telehealth continues to expand. These include ensuring the availability and reliability of internet service, determining costs and accessibility of equipment patients will need to use at home and that physician workflow might slow down during the phase of learning how to provide virtual care. In addition, health care providers must refine the process of educating patients on how to administer their own medications and conduct laboratory draws, as well as improving how they determine if a patient should be seen in-person.
“One can utilize virtual care to identify patients that warrant face-to face-visits; if there’s any question at all, please bring the patient into be seen,” Schreiber advised.
Regarding overall benefits of telehealth, Schreiber highlighted its ability to increase interactions, which aids in combatting depression and isolation during the pandemic. He said that DaVita has developed their own telehealth platform, which allows for video chat with up to 10 parties (including families and caregivers); one area of future focus will be on virtual support groups for patients. The platform, which currently includes scheduling and appointment reminders and educational resources that are available 24/7, has grown substantially during the pandemic with a 5,000% increase in patients with the application downloaded (more than 20,000 patients now use it) and an 11,000% increase in total telehealth appointments.
“What I can tell you is chronic patients are in favor of virtual health,” Schreiber said. “CMS made significant efforts to champion virtual visits during COVID-19. Virtual appointments provide the opportunity to increase connections with patients while helping them stay at the home as much as possible.”
Regarding health care provider views on telehealth, Schreiber said there has been a yearly growth in the rate of physicians who list telemedicine as a skill (less than 20% before the pandemic to almost 50% in 2020.) According to Schreiber, the embrace of telehealth is due, in part, to the fact that health care providers know patients with chronic diseases want telehealth visits.
“The unanswered question is, ‘What specifically will result in this shift to more virtual visits?’” Schreiber asked the audience at the conclusion to his talk. “How are we going to ensure that we get the experience to provide the highest quality care for patients that leads to best clinical outcomes?”