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?