Get help from home: what coronavirus can teach us about telehealth

COVID-19
1

WRITTEN BY: Julia Blanchette, PHD, RN, CDCES

Get your needs met

Avoiding in-person contact helps flatten the Coronavirus (COVID-19) curve and prevent further spread. But what about caring for your essential needs, like visits with your healthcare providers? What if you don’t feel safe disrupting social distancing to see a healthcare provider? As a result of the emergence of COVID-19, most healthcare providers no longer prefer to see you in person! Reducing the number of patients coming in and out of offices helps minimize virus transmission, and protects you and your provider.

In many situations, you can still receive the healthcare services you need without in-person visits. Many healthcare appointments throughout the United States are being scheduled and rescheduled over the phone or over video platforms, otherwise known as telehealth. Telehealth (or telemedicine) is convenient as it allows you to see your healthcare provider using your computer, smartphone, or tablet device. Many healthcare providers, including diabetes providers, are now able to discuss your health data, lab results, and care management plan from the comfort of your own home. What better way to still take care of your own health during a pandemic?

Here are some tips to help you utilize telehealth services to the max!

  • Ask your clinic and insurance plan about the cost before participating in a telehealth visit. There may be a fee associated with your visit, or the cost may be waived.
  • If using a virtual visit app, log in at least 10 minutes before your scheduled appointment to make sure there are no issues.
  • Use your time wisely. The visit may shut down after 15, 20, or 30 minutes (or whatever time slot you have). Plan your questions ahead to best utilize your time.
  • If you are participating in a diabetes visit, try to download your data and send it to your provider in advance. If you are unsure of how to download your data from home, find out ahead of time by going to your data platform website for instructions, or calling your provider for assistance.
  • Know that you may have to wait (patients may be “ahead of you in line”) for on-demand services.

There are still some potential barriers to telehealth to keep in mind:

  • Certain care still has to be done in person, like procedures and surgeries.
  • You may not be able to complete a telehealth visit if you are a new patient. Exceptions are for virtual urgent care or COVID-19 assessment visits.
  • Access to a digital platform is needed. This may be a barrier for those without internet service at home, limited data plans, or for those without smart devices.
  • Your provider may have a specific platform they prefer. Some providers simply call you while others may use Facetime or specific virtual care platform apps, such as AmCare.
  • If you have difficulty using technology, ask other family members or a friend to walk you through it. This is a new experience for all of us!

Adopting this new approach

Fortunately, many previous obstacles to using telehealth, like lack of coverage for those with Medicare, have been resolved. Through new waivers, the Centers for Medicare and Medicaid Services (CMS) has expanded telehealth beyond COVID-19. Previously, only those in designated rural areas were able to receive coverage for these services. Telehealth visits are now covered regardless of the geographic location. This announcement applies to a variety of healthcare services, including specialty visits such as endocrinology, psychology, and medical nutrition therapy. Although there has been significant progress, private insurances still may or may not cover these services. It is recommended to check with your insurance about the cost.

So, is telehealth here to stay? Or will we see it cease to exist when the COVID-19 pandemic slows down? Healthcare providers have been using telehealth services for years, but in limited capacities as patients often prefer what they are used to: seeing providers in-person. However, there has been an uptick in these convenient, virtual services. These services have gained popularity among those who have barriers accessing specialty services, like college students and those who live in remote areas. Additional uses include telehealth offerings from large companies as part of their insurance plans. Currently, providers are also being encouraged to expand telehealth to low-income people, beyond care related to COVID-19.

In the diabetes and endocrine world, telehealth has been utilized for harder to reach populations. For example, the Endo ECHO project, funded by The Leona M. and Harry B. Helmsley Charitable Trust, aims to expand access to services for those who face barriers to care, such as those who live in rural communities. JDRF also had a funding call for psychology and mental healthcare providers to expand the limited mental health services to those with diabetes as well. Additionally, various studies have used telehealth to provide services for those transitioning from pediatric to adult diabetes care.

Many providers and patients have been forced to quickly adapt to this world as a result of the COVID-19 pandemic, but the adoption of telehealth as an alternative to in-person visits was already well underway, and is a transition that is sure to continue.

1 Like
2

Maybe this is indicative of my age group but I am not all in when it comes to telehealth. I will go along with it as long as this pandemic makes it necessary but afterwards I plan to return to the old way of doing things. Don’t judge me wrong, I am technically capable of participating in telehealth, I just don’t think it a good idea.

In my lifetime of visiting doctors I have rarely had a visit where a doctor did not find it necessary to touch my body in some fashion, if for no reason than to check blood pressure and listen to heart beats. I realize that these things are often done for the sheer sake of routine but these routines are there for a reason, they can and do save lives.

Telehealth will degrade the healthcare visit in so many ways. Right now in these times it is a necessary evil, it is something I’m not likely to tolerate when times return to normal.

1 Like
3

I would be more than happy to “tolerate” it! Of course, I’m one of those rural people for whom it’s a complete pain in the butt to get to a doctor. There is exactly ONE endocrinologist on the entire western slope of Colorado, and he’s 3 hours away from me. I was lucky enough to find an internist less than an hour away who is willing to write my scripts, but the necessary mountain roads aren’t often passable in the winter.

Even if I wasn’t rural, though, I would still be a happy adopter of telemedicine. I find that notion of a “doctor has to touch me” to be narrow-minded. We learned to take our own pulse in elementary school. Home blood pressure monitors are easily available and cheap. And let’s not forget how quickly medical tech is advancing. I GARAUNTEE you’ll see more home health monitoring devices develop in the coming years. There were many already in the works before this pandemic, but they’ll surely be spurred further along by it.

We pretty much expect our diabetic brethren to own our disease and be responsible enough to make informed decisions about it, because it’s too “dynamic” to depend fully on a doctor… But why limit it to just diabetes? Our entire bodies and health are dynamic, not just this one facet. I’m perfectly happy to take the responsibility to recognize when something is off and report it to a virtual doctor. I don’t feel any need to be touched by a near stranger to facilitate my health. In fact, I would probably be more inclined to seek an outside opinion if it didn’t involve all the inconvenience, anxiety, and wasted time of a doctor’s visit. Usually, I would put off seeing a doctor until a situation became dire (or more often they refused to refill scripts without seeing me), and I’m definitely not alone in this.

Of course, telemedicine will often still require labwork. There are already places like Minute Clinic and LabQuest all over where lab requests can be sent, without having to go all the way to the doctor, and usually without requiring an appointment.

I think a single annual in-person visit is generous to catch the minor innuendoes that may have been missed in the virtual visits. The reality is that a lot of conditions AREN’T caught by those in-person visits now because doctors are too rushed to dig deep, unless you’re persistent.

1 Like
4

Your post is awesome combined if we see a doctor we really feel could help us but they are not licensed in our state, they are not allowed to help us. That is totally asinine.

1 Like
5

I understand this, for you this would be a better way to receive healthcare. Even in circumstances where there is not limited availability I can see how it would be better for some people especially for patients in a younger age group. Lets face it doctors become a higher priority as we age, never thought I would say that, I spent a large part of my life trying to stay away from the doctor.

It is not narrow minded to want to see a doctor face to face, I have had issues identified in face to face settings that would not have been found using telehealth. At one appointment my NP asked me how long I have had a heart murmur, my answer was wa-wa-what murmur, a second time an irregular heartbeat was heard that was not present before. Both of the conditions are being closely monitored still.

I see telehealth as playing the odds, betting nothing bad will be missed in a televisit. Your age, overall health, your location plus other factors all play into whether you accept the odds. Right now covid-19 makes the odds worth it. I don’t believe I will be able to say that when this threat is diminished.

6

so far my apps has been via phone. my therapist and endo has been via phone. my med nurse (or nurse practitioner at my therapist office) is doing it via Telehealth. so we will be doing video. all of my other apps are in may. so hopefully things will be calm down, etc. but who knows. our lives has changed and the direction of care is different now. we have challenges ahead of us now. some Drs office is closing and only let those that are necessary into the office. my therapist was doing the calls from home vs going into the office. my endo goes into the office to make sure that his calls are known on the phone. and he can update the file of you, etc. so again its all different now and we have to adapt to it.

7

I totally concede you make valid points. I just really hope government/insurance doesn’t take the telemedicine away after the pandemic recedes. I appreciate the choice.

8

I agree. It should be a choice made by you and your doctors

9

Most of my visits are just looking at lab work and asking a few questions. All of which would make me far happier to do from home. Very few have I actually had to be “checked” for something.

My health group sent out an e-mail last week that any elective surgeries, unnecessary procedures and appointments were being canceled. The doctors would do telehealth appointments if needed per approval by your doctor. Please call to re schedule routine appointments. So I had 2 routine appointments in April with my GP and a week later with my Endo.

So I called my GP and they said they would do a Telehealth appointment but my appointment was looking over standard bloodwork which I don’t want to go into a lab either. So I rescheduled the GP in the summer. I hope they will still do Telehealth appointments then.

So I called my endo and they said they were going to switch to Telehealth too and would call me back. I told them I was doing well, my history has been great, nothing is wrong I could skip an appointment because I really don’t want to go to a lab, but I would do what the doctor preferred. I got a call back saying just skip this one and set up an appointment next September.

I then e-mailed for a new prescription for a basal insulin to have on hand in case of a pump failure to be mailed to me by my mail order pharmacy company. Because I don’t want to go to a pharmacy unless I have to either. I always figured I could run out and get it if ever needed to before. This was something I should have done before anyways. I used to have it but it got close to expiring so I gave it away and hadn’t replaced it. The only bad thing about the mail order pharmacy is they are going to send me 3 months supply, so depending how the doc writes it I have not a clue how much I will end up with.