The telemedicine experience: using principles of clinical excellence to identify disparities and optimize care

Abstract

The use of telemedicine has increased significantly during the Corona virus disease 2019 pandemic. This manuscript serves to identify the underlying principles of clinical excellence in telemedicine and to determine whether effective care practices can be generalized as a one-size-fits-all model or must instead be tailored to individual patient populations.A survey assessing care quality and patient satisfaction for patients using telemedicine was created and administered via email to 2 urban cohorts of varying demographics and socioeconomic backgrounds: a population of patients with prior stroke and cerebrovascular disease, and a cohort of patients followed for interstitial lung disease. Results were compared across groups to determine the generalizability of effective practices across populations.Individuals taking part in telemedicine were more likely to be White, more affluent, and woman, regardless of clinical diagnosis compared with a similar cohort of patients seen in-person the year prior. A lower-than-expected number of patients who were Black and of lower socioeconomic status followed up virtually, indicating potential barriers to access. Overall, patients who participated in televisits were satisfied with the experience and felt that the care met their medical needs; however, those who were older were more likely to experience technical difficulties and prefer in-person visits, while those with less education were less likely to feel that their questions were addressed in an understandable way.When thoughtfully designed, telemedicine practices can be an effective model for patient care, though implementation must consider population characteristics including age, education, and socioeconomic status, and strategies such as ease of access versus optimization of communication strategies should be tailored to meet individual patient needs.

Lockdown as the mother of invention: disruptive technology in a disrupted time

“… 6 Patients with ILD who attended telemedicine consultations were more likely to be White, more affluent, and female compared with in-person clinic attendees in the pre-COVID-19 era. 3 The number of patients attending telemedicine consultations who were Black or of low socioeconomic status was lower than expected, suggesting there might be barriers to accessing care in this manner. Older patients were more likely to experience technical issues.…”

“… 2 More than 80% of people with ILD are very satisfied with their experience of telemedicine. 3 Increased use of telemedicine has the potential to increase access to specialist care, which people living with ILD have identified as a high priority. 4 It is no longer a question of whether it is feasible to monitor patients with ILD from a distance; the outstanding questions relate to how we can best implement these technologies in practice, and better understand their effect on specific outcomes.…”

“…Over half of the patients attending a virtual ILDs clinic in the USA during the pandemic reported that they preferred in-person visits to perform routine spirometry and allow their physician to listen to their lungs. 3 Although remote monitoring would enable these assessments to be made at home, this could add to patient burden, with adherence to remote spirometry known to decrease over time. 6 Patients with ILD who attended telemedicine consultations were more likely to be White, more affluent, and female compared with in-person clinic attendees in the pre-COVID-19 era.…”

“…Older patients were more likely to experience technical issues. 3 These data suggest that, beyond the pandemic, we will need to think carefully about how and when we should implement telemedicine solutions (and also when they do not add value), and what support is needed for patients and health systems to use these technologies most effectively.…”

Understanding the telehealth experience of care by people with ILD during the COVID-19 pandemic: what have we learnt?

“…This was particularly true for people with pulmonary disease as it allowed them to undergo pulmonary function tests and have their physician listen to their lungs. Factors associated with a preference for telehealth included male gender, a higher median income and less likely to have comorbidities such as diabetes and hyperlipidemia [15,16]. Findings from our study emphasise the need for the development of an optimal telehealth model that is tailored to meet individual needs, including patient preference, geographic location, age, gender, socioeconomic background, level of technological practical knowledge and availability of resources, whilst enabling HCPs to monitor and continue providing best care.…”