Photo: iStock-Feodora Chiosea
The researchers from UCSF Benioff Children’s Hospital have conducted a study which suggests that telehealth, which has been utilized in response to the COVID-19 crisis, may become a more permanent fixture in our healthcare systems, offering a solution for disparities in healthcare experienced by those who live in rural communities, for example.
The study, published in the Journal of Adolescent Health, noted that by the end of March 2020, a total of 97% of hospital visits at the UCSF Adolescent and Young Adult Clinic were carried out by videoconference rather than face-to-face due to COVID-19 infection control restrictions, contrasting with 100% of appointments being carried out face-to-face before the crisis.
Senior author Marissa Raymond-Flesch, of the UCSF Division of Adolescent and Young Adult Medicine, said: “This has been a complex transition because we have had to navigate the uncertain waters of parent and adolescent/young adult involvement and confidentiality. However, after the current coronavirus crisis, we expect to maintain telehealth in many areas.”
The use of telehealth can raise concerns for health professionals regarding the security of patient data. For the study, the researchers used a video platform that protects the privacy of this data and created a ‘virtual waiting room’ for patients to protect from third-party access, whereby patients are authorized entrance by the doctor.
Appointments that required physical contact, such as vaccines or tests, proved more challenging – with the researchers suggesting that patient’s own devices such as smart watched or blood pressure monitors could be used in the future to allow such appointments to take place virtually.
Raymond-Flesch said: “The telehealth visit is a new reality and one that presents unique challenges. While you can see the patient’s face, you cannot make direct eye-contact and you cannot demonstrate compassion by offering a tissue or a gentle pat on the arm. I found it meant that I had to exaggerate facial expressions or offer more verbal assurance than I would have done in actual visits.”
Patients with eating disorders often have to attend appointments that require physical contact, such as monitoring of weight, vital signs, and electrolytes. However, this can pose challenges for eating disorder patients who may not want to know their weight.
The researchers were successful in weighing some of these patients via a telehealth appointment, and parental help was provided privately in some cases.
“There were concerns that patients would overhear their weight or learn of nutritional interventions that normally parents would discuss confidentially with the physician during an in-person appointment,” said Raymond-Flesch.
“But on the upside, many families travel significant distances to reach us. Telemedicine may have allowed for increased parental participation.”
“There’s a sense that many of the changes are not just temporary responses, but rather the new normal,” she said. “We are not proposing that telemedicine for adolescents and young adults will replace in-person visits, but we can look at this quick shift as an opportunity to reach our patient population in new ways, both in this time of crisis and beyond.
“Patients will be able to complete video visits from school or work or any setting that they identify as adequately private. This is a new domain in our field, and we are excited about reducing disparities in care in underserved areas such as rural communities.”