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Patients have the digital health literacy and tools needed to implement telehealth for after-hours patient-provider communication.

By Sara Heath

October 28, 2020 – Patients are receptive to the idea of using telehealth for patient-provider communication outside of traditional office hours, with about one-fifth saying it would likely get them answers to their health-related questions more quickly, according to a study published in the Journal of the American Board of Family Medicine.

However, a sizeable portion of patients do have concerns that connecting via telehealth may detract from the in-person interpersonal relationships they enjoy with their providers, the study showed.

Telehealth has emerged as a critical tool for connecting patients with their providers when patients cannot come into the office. Notably, the forced shutdown of non-urgent medical appointments during the COVID-19 pandemic sparked an explosion of telehealth and remote patient care.

During that period, some nine million patients used telehealth, according to figures from the Centers for Medicare & Medicaid Services (CMS).

This latest study looked at how telehealth can augment at-home care outside of a global pandemic. Specifically, researchers investigated whether telehealth can help connect patients with clinicians when the clinician office is not open.

Typically, patients encountering a medical problem outside of traditional office hours have to turn to alternative—and often costly—treatment options. The emergency department (ED), specifically, often becomes a fallback for patients who can’t get in touch with their primary care provider outside of office hours.

But the ED and urgent care clinics are notoriously crowded, expensive, and inconvenient. Ideally, a patient could forego these care sites in favor of a telehealth visit outside of office hours with a primary care clinician. This telehealth option could help cut costs and decrease unnecessary ED utilization and overcrowding, the researchers posited.

And patients are largely receptive to this, although they do have some concerns. In a survey of just under 300 adult patients ages 18 to 89 years old, about 20 percent said they agreed telehealth could get them faster answers to their after-hours medical inquiries. Thirty-seven percent said they were concerned they’d lose the personal touch to their patient-provider relationships and communications via telehealth.

Nevertheless, patients do largely appear poised to take on telehealth as an alternative care access option outside of traditional clinic hours. The researchers found most patients have the technology and the health IT literacy to engage in a telehealth consultation.

Three-quarters of respondents said they had access to a device on which they could engage in a telehealth appointment. Patients feeling proficient in device use tended to be younger; as respondents got older, their confidence in using a tool for telehealth waned.

Most older respondents said they had some ailments that could make it hard to use telehealth, including nearsightedness, decrease in cognitive or motor capabilities, or poor hearing.

“Other potential explanations for reduced expertise of technology in older adults include lack of integration of technology into work and personal lives along with decreased self confidence regarding technology use,” the researchers remarked.

“This may be a concern because elderly patients tend to regularly visit the PCP more. However, as technology becomes more heavily integrated into the business and personal aspects of people’s lives at increasingly earlier ages, it is likely that future generations of patients will be comfortable using technology even into old age.”

However, a total of 71 percent of respondents said they enjoyed using video chat, indicating they may be open to a telehealth appointment or consultation with their providers. Individuals with higher educational attainment were more likely to say they enjoy using video chat, with those reporting a college education being three times more likely to say they are “good” a video chat.

With respect to using video chat specifically for a telehealth visit, patients with more experience using video chat or who frequently call their clinicians were more likely to be receptive to the tool.

Patients who previously used video chat were three times more likely to be receptive to a telehealth visit outside of clinic office hours. Patients who said they call their clinicians five or more times each year were more receptive to a video visit than a simple telephone call for after-hours questions.

There are some concerns patients said are better suited for after-hours video calls than others. Issues like cold or flu symptoms, viral gastroenteritis, or musculoskeletal pain would be better to discuss via telehealth. Patients suggested that more extensive medical ailments may still be better treated inside an urgent care clinic or ED where clinicians would have access to more equipment to diagnose or treat the issue.

Those concerns notwithstanding, the researchers concluded that telehealth and video visits could be a viable option for patients with medical issues outside of the traditional office hours.

“By removing accessibility barriers and providing a convenient option for patients, current telephone triage services during after-hours primary care may help to reduce the burden on ED resources, address immediate health concerns, and target a greater range of patients in rural areas who may not be able to access an ED in a timely manner,” the researchers said.

“In addition, such a service maintains continuity of care for patients during after hours, in contrast to Urgent Care facilities, which despite convenience, require patients to meet with a provider who does not know their medical history.”

Moving forward, research may look into how implementing after-hours telehealth triage impacts ED and urgent care utilization. Additionally, deeper surveying on how patients and providers believe telehealth triage could affect communication could help direct system implementation.

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