Telehealth after the pandemic: Will the inverse care law apply? (Commentary)

Abstract

The Covid-19 pandemic has accelerated the use of telehealth within the cystic fibrosis (CF) community to deliver CF care. The article by Solomon and colleagues exploring the patient and family experiences of telehealth care delivery, as part of the CF chronic care model in the US, is therefore timely. In this commentary, we discuss how the US experience of telehealth care compares with reports from CF centres in other parts of the world. We highlight the potential challenges, including whether the inverse care law will apply in this new era of CF telehealth.

The impact of COVID‐19 upon the delivery of exercise services within cystic fibrosis clinics in the United Kingdom

“…Moreover, individual CF centres have detailed the changing practices, acceptance and challenges of integrating telehealth into clinics, 13,14 and therefore, it should be acknowledged that the adoption of telehealth services within CF will also be associated with numerous financial, ethical and local and national regulatory challenges. For example, equity of access to sufficient internet services and technology (e.g., computers and smartphones), patient access to home monitoring devices (e.g., spirometers), clinician access to patients (i.e., for physical examination and collection of sputum and blood samples) and compliance with digital regulations (e.g., generation, transfer and storage of data) will all pose logistical challenges for patients and clinical teams alike to overcome 15–17 …”

A year in review: Real world evidence, functional monitoring and emerging therapeutics in 2021

“…Health care providers and PwCF have adapted to home spirometry, remote microbiological sample collection, blood monitoring and video consultants well [ 7 , 10 , 13 ]. Advantages include less risk of cross infection and convenience for PwCF who are clinically well [ 10 , 14 , 15 ]. However, disadvantages have also been highlighted.…”

“…Over half of adults and parents/carers for PwCF express concerns about lack of in-person assessments such as lung function and microbiological testing [10] . Other disadvantages include the lack of ability to perform a physical examination, difficulties in microbiological surveillance, and the loss of subtleties in communication that may get lost without face to face contact, particularly where there is a language barrier [ 7 , [9] , [10] , [11] , [12] , [14] , [15] , [16] ]. Pediatric teams and parents have been less likely to advocate for remote consultations and have raised concerns regarding monitoring adherence, safeguarding issues, and engaging teenagers [ 8 , 9 , 12 , 14 ].…”

“…Other disadvantages include the lack of ability to perform a physical examination, difficulties in microbiological surveillance, and the loss of subtleties in communication that may get lost without face to face contact, particularly where there is a language barrier [ 7 , [9] , [10] , [11] , [12] , [14] , [15] , [16] ]. Pediatric teams and parents have been less likely to advocate for remote consultations and have raised concerns regarding monitoring adherence, safeguarding issues, and engaging teenagers [ 8 , 9 , 12 , 14 ]. Disparities in high speed internet access and technology may create a ‘digital divide' [ 9 , 12 , 17 ].…”

“…Disparities in high speed internet access and technology may create a ‘digital divide' [ 9 , 12 , 17 ]. Whilst the surge in telehealth has subsided and confidence in returning to face to face visits has grown, in person consultations will probably not return to pre pandemic levels [ 6 , [10] , [11] , [12] , [13] , [14] ]. Health care delivery has evolved and there is much work to do with evaluation and implementation of new hybrid models that address the individual needs of PwCF.…”