A virtual tour of new studies on virtual visits

By Clive Riddle, June 23, 2017 The Advisory Board reports that “up to 77% of consumers would consider seeing a provider virtually—and 19% already have,” according to just published results from their Virtual Visits Consumer Choice Survey of 4,879 U.S. consumers, “designed to better understand the tradeoffs that consumers make when they need different types of care.” The survey found consumers “would be willing to consider a virtual visit in each of the 21 primary and specialty care scenarios tested,” with over 70% of respondents interested in “a prescription question or refill, pre-surgery and select post-operation appointments, receiving ongoing results from an oncologist, and ongoing care for chronic condition management. Select pregnancy checkups, weight loss or smoking cessation coaching, dermatology consults, and psychologist consults also ranked among top offerings.” The survey also addressed consumer telehealth concerns, with 21% citing care quality as their top concern, “followed by the provider not being able to diagnose or treat them virtually (19%), meaning they would have to go to the physical clinic anyway. Only 9% of respondents said they had no concerns about virtual visits.” The current issue of Annals of Family Medicine includes the article “Patient Perceptions of Telehealth Primary Care Video Visits, in which co-authors from the National Academic Center for Telehealth, Thomas Jefferson University conducted “in-depth qualitative interviews with adult patients following video visits with their primary care clinicians at a single academic medical center.” They found that “all patients reported overall satisfaction with video visits, with the majority interested in continuing to use video visits as an alternative to in-person visits. The primary benefits cited were convenience and decreased costs. Some patients felt more comfortable with video visits than office visits and expressed a preference for receiving future serious news via video visit, because they could be in their own supportive environment. Primary concerns with video visits were privacy, including the potential for work colleagues to overhear conversations, and questions about the ability of the clinician to perform an adequate physical exam.“ The May 1, 2017 North Carolina Medical Journal includes the article A Clinical Pharmacist in Telehealth Team Care for Rural Patients with Diabetes which describes a study of the “diabetes telemedicine program funded by the Health Resources & Services Administration and Kate B. Reynolds Charitable Trust was offered in 13 sites in eastern North Carolina, including federally funded Community Health Clinics. A telemedicine team offered interdisciplinary care in the primary care provider's (PCP's) office without the patient needing to travel. The interdisciplinary team included a clinical pharmacist, dietician, behavioral therapist, and physician specializing in diabetes. The PCP referred the patient to 1 or more disciplines depending on the patient's needs. The program targeted underserved rural adults with uncontrolled type 2 diabetes.” The study found that “92% of telehealth patients were ‘very satisfied’ with their care and 83% agreed that telemedicine made it easier to get care.” Referring physicians (vs direct consumer demand) may indeed be the potential driving force for telehealth, at least in rural settings. The current issue of the Journal of the American Board of Family Medicine includes the article Family Physicians Report Considerable Interest in, but Limited Use of, Telehealth Services. A survey of 1,557 Family Practitioners found "15% reported using telehealth services during 2014, and that FPs using telehealth were:  26% more likely to be located in a rural setting; 40% more likely to work in a practice with <6 FPs; 22% less likely to work in a privately-owned practice; and 76% less likely to provide general primary care to patients. Of the FPs using telehealth: 22% used it 1-2 times, and and 26% using it 3-5 times; 55% used telehealth for diagnosis and/or treatment; 68% used telehealth to refer patients to specialists; and 28% used telehealth to refer patients to mental health providers. Still, a rosy future telehealth market is projected according to Hospital & Health Systems 2016 Consumer Telehealth Benchmark Survey results released this month, with health systems cited as a primary driver. They report that “seventy-six percent of U.S. hospitals and health systems either have in place or expect to implement a consumer telehealth program by 2018. Drivers for the rapid adoption growth include the desire to improve access to care, improve care coordination, increase efficiency, prevent readmissions and expand population health programs. In addition, 69 percent of organizations that currently have consumer telehealth programs are planning to expand their offerings, and 76 percent of organizations without consumer telehealth indicate it is a high strategic priority for their organizations.”