Lessons from Rapid Expansion of Telemedicine During the Pandemic
Widespread lockdowns earlier this year in response to COVID-19 pandemic led to the rapid use of telehealth.
A recent study in the Journal of Adolescent Health focused on one health clinic in California serving adolescents and young adults as they rapidly transitioned to telehealth. As was the situation across the country, the clinic went from 0 to almost all (97%) of patient visits occurring via telehealth within a month.
At the same time the clinic was shifting to telemedicine, it also saw an increase in college-aged patients as campuses abruptly closed. They saw college students requiring ongoing treatment with the loss of campus mental health services and an increase in new patients experiencing acute stress responses related to the pandemic.
The study authors from the University of California San Francisco, led by Angela Barney, M.D., highlight challenges and lessons learned and suggest some solutions. The clinicians used various methods to address privacy issues in patients’ homes, such as encouraging patients to use headphones, using yes/no questions when possible, and using the Zoom chat function to limit disclosure to nearby family members. There was initially some concern about some patients not having access to appropriate devices (cell phone, tablet, or computer) but the clinic’s experience was that all their patients had devices.
Barney and colleagues found that working with some patients, such as those with eating disorders or substance use disorders, required additional coordination with psychiatrists, therapists, primary care professionals and family members. One benefit of the transition to telemedicine was the significant savings in time and travel, especially for patients coming from further away.
The authors caution that despite the benefits and success of telemedicine, there will be a need for in-person clinic visits for some individuals, such as those experiencing homelessness or living in abusive or unsafe environments where personal therapy discussions are not possible.
Overall, Barney and colleagues found telemedicine worked well for teens and young adults, however they point to potential concerns around confidentiality, quality of care, and health disparities. They conclude that “the field can look at this quick shift to telemedicine as an opportunity to reach our patient population in new ways, both in this time of crisis and beyond.”
While telemedicine may work easily for most teens and young adults, other populations, such as older adults, may be more challenged. Yet they may be at even greater need of health and mental health service during the pandemic. Older adults may not only be more vulnerable to the effects of COVID-19 but may also be particularly impacted by lockdowns and social isolation.
A Dutch study found that some older adults were less familiar or less equipped to quickly transition to online services and needed support to get online. However, they also cautioned against making assumptions as most of their older adult patients adapted easily to using telehealth.
Another study led by Eric T. Roberts, Ph.D., with the University of Pittsburgh, found that about one in four Medicare beneficiaries did not have digital access (computer or smartphone and internet access/data plan). Individuals with dementia or hearing impairment may have additional challenges with telehealth services.
Among the suggestions to help ensure greater access are covering telecommunication devices as medically necessary and providing accessibility accommodations such as closed captioning for people with hearing impairment. Overcoming potential technological barriers to video can provide important benefits. One study found that compared to phone only visits for older adults with cognitive impairment and for their caregivers, video telehealth lead to increased resilience and improved quality of life. For those needing help, getting set up for online services may offer the potential advantage of preparing them for easier access to other health care services and may help them to stay in touch with friends and relatives, reducing isolation and loneliness.
- Barney, A., et al. The COVID-19 Pandemic and Rapid Implementation of Adolescent and Young Adult Telemedicine: Challenges and Opportunities for Innovation. Journal of Adolescent Health 67 (2020) 164e171
- Naarding, P., et al. COVID-19: Clinical Challenges in Dutch Geriatric Psychiatry, Am J Geriatr Psychiatry. 2020 Aug; 28(8): 839–843. (Published online 2020 May 27)
- Lam, K, Lu, AD, Shi, Y. et al. Assessing Telemedicine Unreadiness Among Older Adults in the United States During the COVID-19 Pandemic. Research Letter. JAMA Intern Med. Published online August 3, 2020. doi:10.1001/jamainternmed.2020.2671
- Roberts, ET, Mehrotra, A. Assessment of Disparities in Digital Access Among Medicare Beneficiaries and Implications for Telemedicine. JAMA Intern Med. Published online August 3, 2020. doi:10.1001/jamainternmed.2020.2666
- Ho-yin, F, Wai-hung, E, Ting-hoi, D. The Protective Impact of Telemedicine on Persons with Dementia and their Caregivers During the COVID-19 Pandemic. American Journal of Geriatric Psychiatry. August 07, 2020DOI:https://doi.org/10.1016/j.jagp.2020.07.019