By Michelle Andrews
Monday, March 06, 2023 (Kaiser News) — When the covid-19 pandemic swept the country in early 2020 and emptied doctors’ offices across the country, telemedicine suddenly came into the limelight. Patients and their doctors have turned to virtual visits over video or phone rather than risk meeting in person.
During the first months of the pandemic, telehealth visits for care skyrocketed.
“It was a sea change in a week or two that we expected to see in a decade,” said Dr. Ateev Mehrotra, a professor at Harvard Medical School whose research focuses on telemedicine and other innovations in in the provision of health care. “It is good that we have served patients, but we have not accumulated the standards and [research] papers we would normally hoard in order to find out what works and what doesn’t.
Today, three years after the start of the pandemic, we are still finding out. Although the use of telehealth has moderated, it has found a role in many medical practices and is popular with patients.
More than any other field, behavioral health has embraced telehealth. Mental health issues accounted for just under two-thirds of telehealth claims in November 2022, according to FairHealth, a nonprofit that maintains a large database of private insurance and Medicare claims.
Telehealth appeals to a variety of patients because it allows them to simply log on to their computer and avoid the time and expense of driving, parking, and arranging childcare that an in-person visit often entails. .
But how do you assess when to opt for a telehealth visit versus seeing your doctor in person? There are no hard and fast rules, but here are some pointers on when it might make more sense to choose one or the other.
If this is your first visit
“As a patient, you’re trying to assess the doctor, see if you can talk to him and trust him,” said Dr. Russell Kohl, family physician and board member of the American Academy of Family Physicians. “It’s hard to do that on a telemedicine visit.”
Maybe your insurance has changed and you need a new primary care doctor or OB-GYN. Or maybe you have a chronic illness and your doctor has suggested that you add a specialist to the team. A visit in person can help you feel comfortable and confident with their participation.
Sometimes a first in-person visit can also help doctors assess their patients in intangible ways. After a diagnosis of cancer, for example, an oncologist may want to examine the site of a biopsy. But just as important, he might want to assess a patient’s emotional state.
“A cancer diagnosis is an emotional event; it’s a life-changing moment, and a doctor wants to respond to that,” said Dr. Arif Kamal, oncologist and chief patient officer at the American Cancer Society. “There are things you can miss unless you’re sitting a foot or two from the person.”
Once it is clearer how the patient is coping and reacting to treatment, this is a good time to discuss integrating telemedicine visits.
If a physical examination seems necessary
This may seem obvious, but there are nuances. Increasingly, monitoring equipment that people can keep at home – a blood pressure cuff, a digital glucometer or stethoscope, a pulse oximeter to measure blood oxygen, or a Doppler monitor that checks heart rhythm of a fetus – can give doctors the information they need, reducing the number of in-person visits required.
A person’s overall physical health can help tip the scales on the need for an in-person exam. A 25-year-old in good general health is generally a better candidate for telehealth than a 75-year-old with multiple chronic conditions.
But some health conditions usually require an in-person examination, doctors said, such as abdominal pain, severe musculoskeletal pain, or eye and ear-related issues.
Abdominal pain can signal a problem with the gallbladder, liver, or appendix, among other things.
“We wouldn’t know how to assess it without an exam,” said Dr. Ryan Mire, an internist who is president of the American College of Physicians.
Unless a doctor performs a physical exam, too often children with ear infections are given prescriptions for antibiotics, Mehrotra said, citing a study he co-authored comparing prescribing differences between children. telemedicine visits, emergency care and primary care visits.
In obstetrics, the pandemic has accelerated the gradual shift to fewer in-person prenatal visits. Typically, pregnancy involves 14 in-person visits. Some models now recommend eight or fewer, said Dr. Nathaniel DeNicola, chair of telehealth for the American College of Obstetricians and Gynecologists. One study found no significant difference in rates of cesarean delivery, preterm delivery, birth weight or neonatal intensive care unit admissions between women who received up to one dozen in-person prenatal visits and those who received a combination of in-person and virtual visits. visits.
Contraception is another area where less can be more, DeNicola said. Patients can virtually discuss the pros and cons of different options and may only need to schedule a visit if they want an IUD inserted.
If anything is new or changes
When a new symptom appears, patients usually need to schedule an in-person visit. Even if the patient has a chronic condition such as diabetes or heart disease that is under control and care is managed by a familiar physician, sometimes things change. This usually requires a face-to-face meeting as well.
“I tell my patients, ‘If it’s new symptoms or an aggravation of existing symptoms, that probably warrants an in-person visit,'” said Dr. David Cho, a cardiologist who chairs Health Care. American College of Cardiology Innovation Council. Changes may include chest pain, loss of consciousness, shortness of breath, or swollen legs.
When patients sit in front of him in the exam room, Cho can listen to their heart and lungs and do an EKG if anyone has chest pain or palpitations. He will check their blood pressure, examine their feet to see if they are retaining fluid, and examine the veins in their neck to see if they are bulging.
But all of that may not be necessary for a patient with heart failure, for example, who is in stable condition, he said. They can check their own weight and blood pressure at home, and a periodic video visit to check may be enough.
Video recordings are effective for many people whose chronic illnesses are under control, experts said.
When someone is undergoing cancer treatment, there are crucial moments that will require an in-person meeting, said Kamal of the American Cancer Society.
“The cancer has changed or the treatment has changed,” he said. “If they want to stop chemotherapy, they have to be there in person.”
And a clear recommendation applies to almost all situations: even if a doctor or an office planner suggests a virtual visit, you don’t have to accept it.
“As a consumer, you should do what you feel comfortable with,” said Dr. Joe Kvedar, a professor at Harvard Medical School and former chairman of the board of the American Telemedicine Association. “And if you really want to be seen in the office, you should.”
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with policy analysis and polls, KHN is one of the three main operating programs of the KFF (Kaiser Family Foundation). KFF is an endowed non-profit organization providing information on health issues to the nation.
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