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Is Telemedicine In Primary Care Here to Stay?

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As the world closed down, patients and healthcare workers turned to telemedicine to stay connected. But is it here to stay?

Specializes in DNP-FNP Student, Pediatric ICU Nurse. Has 4 years experience.

Will the world embrace telemedicine?

Is Telemedicine In Primary Care Here to Stay?

Due to the current global pandemic, telemedicine has become more relevant than ever in primary care. This external threat is forcing providers and patients to stay apart as a broader public health initiative to maintain the spread of COVID-19. This technology allows patients to receive care without the in-person contact. Under an emergency declaration in conjunction with the 1135 waiver authority and Coronavirus Preparedness and Response Supplemental Appropriations Act, Medicare has temporarily broadened its access of telemedicine, delivering benefits to patients while containing community spread (Centers for Medicare & Medicaid Services, 2020). As more patients and providers adopt this healthcare delivery platform during this worldwide crisis, it has the potential to create a fundamental impact on the primary healthcare landscape.

Telemedicine is widely embraced by specialty areas of medicine. Although there is an overall general increase of use of telemedicine in primary care, it is still not universally employed (Barnett et al., 2018). The volume of telemedicine claim lines has increased over 4,000 percent from March 2019 to March 2020 across the United States. While meaningful increases, wider implementation of telemedicine can improve patient outcomes, decrease chronic disease burdens, and ensure financial stability (American Medical Association, 2020). Furthermore, telemedicine has the opportunity to increase continuity of care between providers and patients as frequent follow-ups are easier to achieve.

Primary care providers [PCPs] have limited access to telemedicine due to barriers put in place by Medicare and these barriers are only lifted in times of need (American Hospital Association, 2019). In March of 2020, Medicare has temporarily broadened access of telemedicine during this current public health crisis, which helps to alleviate the stress of the public health crisis on the healthcare system (Centers for Medicare and Medicaid Services, 2020). 

Primary Care Provider Response to Public Health Crises

The literature demonstrates studies have been conducted to describe the response of PCPs to public health crises. Researchers found that PCPs experiences are crucial for improving future prepandemic planning, which is a relatively new phenomenon (Kunin et al., 2013).  PCPs experienced lack of confidence dealing with new and potentially life-threatening disease. Additionally, PCPs faced other problems associated with performance of public health responsibilities including surveillance, reporting, and privacy concerns (Kunin et al., 2013). Tomizuka et al. conducted a cross-sectional study that surveyed physicians based on World Health Organization checklists and essential components of institutional preparedness (2013). The researchers describe the necessity of a business continuity plan, or a plan that provides guidance on how to provide essential practice functions, staffing modifications, and record keeping during times of a public health crisis; however, this contingency plan was not implemented, and, therefore, creating a disruption in the local healthcare system (Tomizuka et al., 2013). During public health crises, PCPs and nurses are required to implement unique clinical skills. Other researchers described how clinical decision-making skills were different on the frontlines of the public health crisis, since regular office visits were suspended to control the spread of the virus (Verhoeven et al., 2020). Many PCPs and nurses expressed concern about the continuity of regular care, communication barriers to patients, and concern that certain cases would be missed due to less information gathered over the phone (Verhoeven et al., 2020).

Trends of Telemedicine

Healthcare is moving from fee-for-service to a value-based approach, and telemedicine has the capability to respond to the changing landscape of delivery (American Hospital Association, 2019).  Barnett et al., conducted a retrospective chart review to examine trends in telemedicine utilization within a large commercial health plan (2018). The researchers found that annual telemedicine visits among all members increased from 206 to 202,374 from 2005 to 2017, and a rapid increase in growth from primary care telemedicine in 2016 and 2017 after coverage for direct-to-consumer telemedicine expanded (Barnett et al. 2018).

Patient Perception of Telemedicine

Many studies have concluded that patient perception of telemedicine is overall positive. In one study, 99% of the patients reported being very satisfied with all telemedicine attributes, and the majority reported the telemedicine visit just as good as a traditional visit (Polinski et al., 2015). The researchers reported an overall high satisfaction with telemedicine experience and quality of care were important to patients. Convenience was a recurring theme of telemedicine visits (Polinski et al., 2015, Powell et al., 2017). Powell et al. examined patient experiences with video visits with their established PCPs and reported that participants even preferred video visits over in-person visits; however, some participants expressed the loss of physician-patient connection, although this was not significant (2017). Despite some patients experiencing the lack of a personal connection, most patients felt telemedicine empowered them to manage their health (Hanley et al., 2018)

It has been shown that telemedicine has a necessary place during the pandemic. But the question remains ...

... once we go back to our “normal lives,” will telemedicine in primary care be here to stay?

sabrinaplatt is a DNP-FNP Student and has 4 years experience as a BSN, RN specializing in Pediatric ICU.

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11 Comment(s)

toomuchbaloney

Has 43 years experience.

It's here to stay if the insurers and corporate interests believe that it is a pathway to profit.  

SmilingBluEyes

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis. Has 24 years experience.

We are stuck with it. I don't approve in my setting cause we have to stop what we do and take the Ipad to each patient to facilitate the telemedicine visit. It's OK when I am not super busy but when I am, it's an imposition on my day. The doctor gets to charge for the visit and my day is sidelined for the couple hours this happens.

Views on never seeing the patient face-to-face in clinic? Would providers want to meet the person for an initial consult? How can you do an appropriate assessment via video?

toomuchbaloney

Has 43 years experience.

52 minutes ago, 2BS Nurse said:

Views on never seeing the patient face-to-face in clinic? Would providers want to meet the person for an initial consult? How can you do an appropriate assessment via video?

Maybe it depends upon the circumstances...

NurseSpeedy, ADN, LPN, RN

Has 19 years experience.

9 hours ago, 2BS Nurse said:

Views on never seeing the patient face-to-face in clinic? Would providers want to meet the person for an initial consult? How can you do an appropriate assessment via video?

Many initial visits via Telehealth are now requiring a face to face exam after in some specialties. It limits the time in the actual office, but is now two separate visits to establish treatment.

nursej22, MSN, RN

Specializes in Public Health, TB. Has 36 years experience.

I've done both in the past year, depending on circumstances. Televisit to discuss labs and reorder lipitor, in-person for pacer interrogation. Worked fine for me and quicker with no need to travel and expose myself to unvaccinated staff. 

7 hours ago, nursej22 said:

I've done both in the past year, depending on circumstances. Televisit to discuss labs and reorder lipitor, in-person for pacer interrogation. Worked fine for me and quicker with no need to travel and expose myself to unvaccinated staff. 

For a simple Lipitor refill yes. What about a new patient the specialist hasn't ever seen, I.e. an uncontrolled T1D?

nursej22, MSN, RN

Specializes in Public Health, TB. Has 36 years experience.

12 hours ago, 2BS Nurse said:

For a simple Lipitor refill yes. What about a new patient the specialist hasn't ever seen, I.e. an uncontrolled T1D?

The original topic is about primary care, which to me involves the interaction between primary care provider and a patient. An in-depth, exam, such a establishing care with a specialist would almost certainly be done in-person. I am establishing care with a new cardiologist in a week, and will be seeing her in person. 

sabrinaplatt, BSN, RN

Specializes in DNP-FNP Student, Pediatric ICU Nurse. Has 4 years experience.

On 8/18/2021 at 1:38 PM, toomuchbaloney said:

It's here to stay if the insurers and corporate interests believe that it is a pathway to profit.  

You make a valid point. It seems as if the insurers drive a lot of medical decision making processes.

On 8/23/2021 at 9:13 AM, nursej22 said:

The original topic is about primary care, which to me involves the interaction between primary care provider and a patient. An in-depth, exam, such a establishing care with a specialist would almost certainly be done in-person. I am establishing care with a new cardiologist in a week, and will be seeing her in person. 

I believe establishing care, whether in primary care or with a specialist, should be done in person. Good luck with your new cardiologist!

sabrinaplatt, BSN, RN

Specializes in DNP-FNP Student, Pediatric ICU Nurse. Has 4 years experience.

On 8/22/2021 at 1:13 PM, nursej22 said:

I've done both in the past year, depending on circumstances. Televisit to discuss labs and reorder lipitor, in-person for pacer interrogation. Worked fine for me and quicker with no need to travel and expose myself to unvaccinated staff. 

I like your point about not exposing yourself to unvaccinated staff. Not only does telemedicine keep you connected to providers, it can also decrease exposure risk.

On 8/18/2021 at 1:49 PM, SmilingBluEyes said:

We are stuck with it. I don't approve in my setting cause we have to stop what we do and take the Ipad to each patient to facilitate the telemedicine visit. It's OK when I am not super busy but when I am, it's an imposition on my day. The doctor gets to charge for the visit and my day is sidelined for the couple hours this happens.

I hadn't thought about the work flow- how you have to stop and start to change formats for patient visits. Thank you for bringing this up!

Yes, workflow is a huge issue. Either your front office staff or the clinical staff have to establish a video connection with the provider (and trouble-shoot which can take up to a half-hour and causes arguments among staff). The clinical staff are required to reconcile medications, medical history, pharmacy (basically anything you would do in person). We also enter a possible vital signs taken at home as "patient recorded". Connection problems can lead to poor satisfaction scores even if the fault doesn't lie with the clinic.