Telehealth initiatives have historical precedent with respect to extending health care services to patients living in rural areas. It is increasingly being recognized as a feasible means of meeting some of the health needs of underserved populations. This article talks about utilizing telehealth initiatives in a way that deviates from traditional manner—managing chronically ill patients.
Several years ago, in 2009, Massachusetts General Hospital (MGH) launched a pilot of conducting virtual visits with patients who had chronic conditions such as diabetes, depression, and arthritis. The vast majority of patients were left satisfied spurring MGH to expand the pilot and launch a full-fledged virtual visits program at the clinic. These virtual visits were not conducted in real-time. Rather, after a patient is initially seen in-person at the clinic, a virtual visit is scheduled. The physician determined the appropriate time for a follow-up visit and the patient is sent an email notification with a link to a questionnaire. Apparently, the questionnaire entails questions that the doctor would have simply asked during the in-person visit. Once it’s submitted, the doctor responds within a day to discuss next steps.
In some ways, it is suspected that the ability for patients to take their time answering the prompts in the questionnaire and to engage in some reflection facilitates greater honesty and transparency. This has led to improved outcomes for some patients, such as with respect to psychiatric illness.
Physicians are currently advocating for telemedicine to be covered by Medicare (1). They assert that telemedicine would prove to be a viable way of cutting health care costs in this country without compromising on care. With the recent pilot focusing on chronically ill patients rather than solely on patients living in rural regions, could telemedicine in fact emerge as a means of significantly alleviating health disparities in this country? Patients who are unable to adhere to medication regimens, follow dietary or exercise recommendation, or to be present for diagnostic tests or follow up visits also tend to be those who are dealing with the adverse effects of social factors such as job insecurity, poor housing conditions, and so forth. With patient satisfaction and overall quality of care being pivotal components of the new wave of delivery of health care services due to the ACA, telemedicine may indeed develop into an influential means of addressing health inequity in this country.
(1) http://www.aafp.org/news/practice-professional-issues/20140624telemedicine.html
Tehreem Rehman, MD MPH 