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Trends in the Use of Telehealth in the US During the Pandemic

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The coronavirus has changed several aspects of the healthcare system in America. However, the one aspect that has seen the most dramatic change has to be telemedicine. Even though virtual care has been in place long before COVID-19, they have only become a popular option after the state-mandated, lockdown orders. And since then, it has remained strong. The pandemic has made this new era of medicine and the healthcare system a necessity. They are now the core aspect of the relationship between a patient and a provider. Read on to learn about the trends of telehealth in the United States during the pandemic.

Telemedicine and mental health

As per the data provided by athenahealth’s dashboard, telemedicine had the most significant impact on mental health cases with almost 33% of all the appointments conducted virtually. This is because telehealth services can lend themselves fairly easily to mental health as since you are talking to someone, you can do it from any corner of the world. COVID-19 pandemic didn’t just make everyone stuck at their home but also caused a lot of mental stress in regards to the loss of a loved one or job insecurity. These consequences had a major impact on the mental health of Americans leading to anxiety and depression becoming one of the most common issues they face.

Another survey that was conducted in June 2020 by the Centers for Disease Control and Prevention concluded that over 40% of the participants reported an adverse behavioral or mental health condition and about 11% of them had considered suicide in the past month. With so much stress ongoing because of the pandemic, telehealth as the mental health treatment option has become a non-negotiable for several people. Apart from the increasing need for mental health treatment, telehealth also made it easier for people who couldn’t seek care for themselves before. Because of the lockdown, they can now schedule appointments in the middle of the day without missing out on school or work.

The flexibility offered by telehealth services has also allowed people to enjoy a certain level of discretion. This is especially beneficial for people who don’t want to be seen entering or leaving their psychiatrists’ offices during regular visits. Thanks to telehealth, more people are able to seek help for their mental health issues. And, the more people try out therapy, the less stigmatized it will become.

Telemedicine and primary care

Another revelation from the athenahealth dashboard was that the second largest percentage of the telehealthcare appointments was primary care, with 17% of all visits being held virtually. One of the most important parts of primary care is talking to the doctor. It’s about telling the doctor about the issues that you are facing. Also, most of the primary care visit’s physical aspects like measuring blood pressure and weight can now be done using inexpensive equipment right from the comfort of your home. There are some other examinations that might require a camera. Overall, all these issues can be dealt with virtually.

According to the data provided by the Blue Cross Blue Shield of Massachusetts, the top reasons for the primary care in the area of telehealth claims are general exams, lower back pain, hypertension, pelvic or abdominal pain, insomnia, anxiety, or asthma. Out of the 7.5 million telehealth appointments that were made during the pandemic, 40% were by phone and 60% were virtual.

Telehealth appointments have also forced doctors to let go of the more traditional practices of medical care that include ordering imaging tests or lab work and decreased unnecessary testing. So, when they are taking a telephonic visit, they think long and hard about whether the patients should visit a testing service to get radiology or other tests.

Telehealth vs in-person appointments

The athenahealth data also showed that compared to in-person visits, telehealth appointments are two times more likely to be scheduled on the same day. Also, they were more likely to occur on the weekends or after-hours. The flexibility offered by telehealth has helped the doctors make sure that they cater to in-person as well as virtual appointments. Also, since there will be fewer patients in the office, creating social distancing opportunities will be easier.

Another aspect in which telehealth appointments gain an advantage over in-person visits is the duration. Compared to in-person appointments, telehealth appointments can be completed in under 15 minutes. Now, some patients might think that this will decrease the quality of health care they receive. But, as per doctors, this is a sign of efficiency that helps improve the quality of healthcare. During in-person appointments, the doctors usually spend about two to five minutes moving from one cabin to another, checking something on the file, pausing to document, or handing something off. This is the time that they are not spending with the patient and it results in inefficiency. However, with telehealth, everything is electronic meaning that these inefficiencies won’t be taking up any of the doctor’s time.

Telehealth and the veterinary industry

The coronavirus also had a large impact on the veterinary community, affecting every single part of their lives. Veterinary professionals had to act quickly in order to continue serving animals and ensuring the safety of everyone involved. The pandemic completely changed the way they took care of their patients. They moved to curbside care, limited and even removed the face-to-face interactions considered essential for connecting and communicating with the clients effectively. In order to deal with the travel restrictions, mandated lockdowns, and the unpredictability of the virus, the veterinary industry had to get creative and this is where telehealth comes into place.

During the early months of the pandemic, a report by the Centers for Disease Control and Prevention analyzed the trends of telehealth. Compared to the last year, there was a 154% increase in telehealth visits in the last week of March in 2020. Most of the telehealth visits were related to non-COVID-19 conditions. There was a similar trend in the veterinary space. Even though the word telehealth and telemedicine are used interchangeably, telemedicine is a category under telehealth. In veterinary practice, telemedicine is described as the usage of an electronic tool for exchanging information about the health status of a patient and getting a valid VCPR – veterinarian-client-patient relationship. This can include observing the patient and communicating with the client electronically.

Before the coronavirus, federal law mandated that in order to establish a VCPR, an in-person physical examination was required. Also, a VCPR was considered necessary for diagnosing, prescribing medication, or treating a veterinary patient. But, during the pandemic, a few states allowed the establishment of the VCPR through virtual means to balance veterinary care’s provisions with the observance of quarantine or lockdown guidelines and social distancing. Also, the FDA, Food and Drug Administration, elected to suspend a few aspects of federal VCPR requirements temporarily, especially the ones related to governing the veterinary feed directives and extra-label drug use in the animals. This was done to widen the veterinary telemedicine utilization during the pandemic.

However, the FDA noted that even with the temporary suspension, veterinarians will have to follow the VCPR requirements that were set by their states. In the absence of VCPR, telehealth appointments for animals are limited to educational content, general opinion or advice, and teletriage (a method of assessing the conditions of the patient electronically to see if a referral to a veterinarian is warranted or not).

Even with the increased ease of access to telemedicine, there are many sick pets who have to visit a veterinary hospital to get diagnostic care. But, the usage of telehealth in the industry has definitely expanded with the hospitals using telephone or audiovisual more frequently than in-person in order to communicate with the clients. It is the perfect way of demonstrating to the clients how to take care of their pets at home while maintaining social distancing protocols. This includes general health monitoring, subcutaneous fluids, injections, administration of oral medications, or provision of nutrition.

During the pandemic, there was an increase in pet ownership which overwhelmed the veterinary hospitals. However, there has also been an increase in the accessibility and availability of veterinary care. A lot of companies have built and expanded their applications to provide online or remote veterinary services. The best part is that these services can help the pet owners, who otherwise wouldn’t have been able to seek veterinary care because of their geographical or financial constraints. It will also be used widely by owners who want access to good pet care right at their fingertips.

Even though the permitted provisions for the establishment of VCPR without having an in-person examination have been lifted by some states, there is still not a lot of information available on whether these regulations are temporary or whether the veterinary telemedicine landscape is continuing to evolve. According to the American Veterinary Medical Association (AVMA),

“With the exception of emergency teletriage, including poison control services, the AVMA opposes remote consulting, including telemedicine, offered directly to the public when the intent is to diagnose and/or treat a patient in the absence of a VCPR.”

Telehealth and the rural population

There was a study published in the Journal of Medical Internet Research that evaluated the changes in the use of telemedicine among rural populations and identified the characteristics of telemedicine use before and during the global pandemic. To do this, they conducted a cross-sectional study on all quarterly and monthly rural telemedicine visits starting from January 2012 to June 2020. What they found was that before the pandemic, the use of telehealth was low for both rural as well as urban populations, but was slightly higher for rural patients. In June 2020, the rate of telehealth visits among the rural population increased significantly. For the urban patients, a similar, but the steeper curve was observed. Also, telemedicine use increased among all age groups. The highest rates were reported among senior citizens with an age of more than 65 years.

Overall, the conclusion of the study was that during the coronavirus pandemic, telehealth adoption has significantly increased in rural areas. Future studies should conduct an investigation of the barriers to telehealth use among patients from rural areas and the impact rural telehealth has on the patient’s health care utilization.

As of May end 2021, more than 40% of the US population have been fully vaccinated. And, as we are getting closer to normalcy, it is unclear on the changes the healthcare industry will be facing, especially since the temporary telehealth policies will expire at the end of the public health emergency (PHE). There have been a lot of changes to the federal regulatory trends and state legislation over the past year. Thanks to these series of changes, the telehealth industry was able to meet the demand while ensuring that precautionary measures were followed.

Even though the coronavirus pandemic has slowed down and the lockdown has been lifted in most places, it is unlikely that the United States is going to fall back to the traditional use of telemedicine. There have been a lot of people who have wanted to reduce the gap between healthcare provision and technology for a long time, even before the pandemic. What happened because of the coronavirus, for better or worse, was that the telehealth industry was freed from all the regulation issues that stopped people from accessing virtual care. But, what about the future?

Experts believe that telehealth will be the future of reimbursement status. There were a lot of temporary changes made to the reimbursement policies during the coronavirus pandemic that led to the conversation on the payer community and the policy front. Now, whether these changes will be made permanent is the point of uncertainty for healthcare providers and the general public like you. Many of the hospitals will continue providing support and consultation online. But, there is one thing that is confirmed is that with the right policy changes, telehealth can be made the safest, most affordable, most accessible, and most efficient form of healthcare in the country.

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