Telemedicine is not right for every patient.

Value-Based Care

Does GI Telemedicine Serve All Equally?

"Telehealth holds the potential for unintended consequences that may disadvantage patients who have reduced digital literacy, lack consistent Internet access, and have visual and/or hearing impairments."

The rapid expansion of telehealth services in the last year has led some to consider to what extent these remote care practices should remain in place in a post-pandemic world.

A key question in that debate is whether telehealth benefits all patient populations equally.

“Telehealth holds the potential for unintended consequences that may disadvantage patients who have reduced digital literacy, lack consistent Internet access, and have visual and/or hearing impairments,” according to a review article published in the American Journal of Gastroenterology in October 2020.

The brief overview below explores various advantages and disadvantages in telemedicine documented by gastroenterologists since the pandemic began. How can gastroenterologists address potential discrepancies in care? Read on for answers.

Telehealth Benefits in Gastroenterology

Speaking with a doctor from home or the office helps patients save time and money on travel, childcare, and potentially lost time from work.

Prior to the pandemic, a survey of veterans needing endoscopic retrograde cholangiopancreatography (ERCP) in Michigan found that patients preferred telehealth options for pre-procedural visits. This study — initially presented at the annual American College of Gastroenterology (ACG) meeting in 2019 — pointed to one clear telemedicine benefit: reduced travel time.

Remote pre-procedure appointments can be a great advantage for patients who may need to travel hours for an advanced endoscopic procedure, the study showed.

But, even patients with chronic GI conditions also find telehealth to be convenient and timesaving, according to a recent survey of gastroenterology patients in Israel. Younger patients with inflammatory bowel disease (IBD) reported the highest satisfaction rates with telemedicine during the pandemic. This is likely due to frequency of required visits for IBD patients, according to the study authors.

Telemedicine may also include remote monitoring of patients, not simply appointments by phone or video. A recent editorial in Becker’s GI & Endoscopy explored how two practices in New Jersey and Illinois used a remote monitoring and engagement strategy for patients with chronic GI conditions like Crohn’s disease last year.

Hospitalizations reduced 50 percent for patients involved and patients spent an average $6,500 less on healthcare throughout the year, according to the article

Shortcomings of Remote Options

The October 2020 review in the American Journal of Gastroenterology referenced above found that GI patients older than 60 were more likely to do a telehealth visit by phone than rather than video conference. This data was collected from the Massachusetts General Hospital in the early months of the pandemic.

Video visits help clinicians make more complete assessments of a patient’s health, according to the review.  Ultimately, the ability for patients to use video conferencing technology also greatly correlated with telehealth satisfaction, the authors wrote.

“Tailored implementation strategies accounting for the various patient populations will be required to develop sustainable and equitable telehealth programs,” the review concluded.

Other potential pitfalls of telemedicine include:

  • Not feeling as cared for
  • More difficult to communicate with a healthcare professional
  • Less time spent with a healthcare professional
  • Lower quality of care

This is according to a survey of adults ages 50 to 80 conducted by the University of Michigan National Poll on Healthy Aging in May 2019. About 47 percent of patients surveyed reported telehealth was more convenient, despite potential drawbacks. Patients surveyed were not specifically gastroenterology patients.

Honing Telemedicine Skills

Since Internet access may be an issue for some patient populations, particularly in rural areas, providers need to assess whether telemedicine is even appropriate for some patients. This is according to a review article published by a panel of gastroenterologists in the American Journal of Gastroenterology late last year.

Patients should be asked about any potential technology limitations prior to scheduling a remote appointment, according to the review.

The panel suggests gastroenterologists thoroughly review different platforms and outlines several options including GI OnDEMAND, Doxy.me, and EPIC, all promoted by ACG. GI OnDEMAND may be particularly helpful for gastroenterologists as the platform includes disease-specific educational services for patients.

It may be beneficial for providers to focus on providing telemedicine for a target patient group that would benefit most from the service, now that practices are starting to reopen. Then, as providers improve upon using the technology, begin to offer the option to more patients.

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