Telehealth and Public Health Practice in the United States—Before, During, and After the COVID-19 Pandemic

Abstract

Telehealth is the use of electronic information and telecommunication technologies to provide care when the patient and the provider are not in the same room at the same time. Telehealth accounted for less than 1% of all Medicare Fee-for-Service outpatient visits in the United States in 2019 but grew to account for 46% of all visits in April 2020. Changes in reimbursement and licensure policies during the COVID-19 pandemic appeared to greatly facilitate this increased use. Telehealth will continue to account for a substantial portion of care provided in the United States and globally. A better understanding of telehealth approaches and their evidence base by public health practitioners may help improve their ability to collaborate with health care organizations to improve population health. The article summarizes the Centers for Disease Control and Prevention's (CDC's) approach to understanding the evidence base for telehealth in public health practice, possible applications for telehealth in public health practice, and CDC's use of telehealth to improve population health.

Social Participation and Navigation: Formative Evaluation of a Remote Intervention for Autistic Adolescents and Young Adults

“…Although remote interventions in occupational therapy were active before the COVID-19 pandemic ( American Occupational Therapy Association [AOTA], 2021 ), lockdowns precipitated a fast, broader transition to telehealth for worldwide health care ( World Health Organization, 2020 ). This transition created opportunities for many organizations and clinicians who continue to use telehealth, preferring video-based meetings for their ease of use and ability to reach more clients ( Neri et al, 2022 ). Recent research demonstrated the efficacy of telehealth-based occupational therapy services among various populations ( Little et al, 2021 ; Nissen & Serwe, 2018 ).…”

Paediatric antibiotic prescribing in a nationwide direct-to-consumer telemedicine platform in France, 2018–2021

“…For example, in the USA, teleconsultation went from accounting for less than 1% of Medicare primary care visits before 2020 to 46% of all visits in April 2020. 9 Similarly, in France, the national health insurance system started reimbursing teleconsultations in September 2018, but the use of teleconsultation actually took off during the COVID-19 pandemic: reimbursement claims counted 9.4 million teleconsultations in 2021 compared to only 80 000 in 2019, and in 2021, approximately 4% of all general practice visits were teleconsultations. 10…”

Telehealth use and work stress among Chinese health care providers during the COVID-19 pandemic

“…HCPs provide care and interact with interprofessional team members (e.g., nurses, social workers, and pharmacists) and patients use telehealth in new ways that potentially increase HCPs' stress while offering opportunities for intime communication and innovation [9,10]. Telehealth practice changes have significantly reshaped the landscape of healthcare provision for providers [11]. As highlighted by Smith et al (2019) in the Journal of Telemedicine and Telecare, HCPs now experience enhanced work flexibility, yet face challenges with altered patient interactions due to the lack of physical contact.…”

“…As highlighted by Smith et al (2019) in the Journal of Telemedicine and Telecare, HCPs now experience enhanced work flexibility, yet face challenges with altered patient interactions due to the lack of physical contact. They have had to quickly adapt to new technological demands, grapple with complexities in electronic documentation, and navigate evolving licensing and reimbursement policies [11]. Moreover, while telehealth has expanded access to diverse patient demographics, HCPs are also facing the possibility of increased screen-induced fatigue and burnout [9].…”

“…Telehealth adoption, especially during its introductory phases, has been observed to aggravate the stress of HCPs [11]. In the past, many HCPs have reported a variety of experiences, with some describing notable barriers to telehealth integration, including lack of familiarity with and training in its use, diminished face-to-face interactions with patients, and technical challenges [4,16].…”