Telehealth visits expected to remain important in endocrine care
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Telehealth medical visits are expected to continue to be an important factor in endocrine care, according to an Endocrine Society policy perspective.
“Telehealth will likely remain a common modality for endocrine care after conclusion of the current public health emergency,” Varsha G. Vimalananda, MD, MPH, a physician-scientist at the Center for Healthcare Organization and Implementation Research at the Veterans Affairs Healthcare System in Bedford, Massachusetts, and associate professor in the department of medicine in the section of endocrinology, diabetes, nutrition and weight management at Boston University School of Medicine, and colleagues wrote. “Thus, clinicians will need to decide whether it is appropriate to use telehealth outside a public health emergency for specific types and instances of endocrine care. Few empiric data are available to guide decisions about when to leverage telehealth or in-person encounters for endocrine outpatient care.”
The Endocrine Society created a panel of nine U.S. endocrinologists with expertise in telehealth critical care, telehealth operations, patient-centered care, health care delivery research and/or evidence-based medicine. The panel conducted a literature search and identified studies published since 2000 regarding telehealth in endocrinology. The panel listed factors that affected the quality of endocrine care through telehealth and grouped these factors into the following domains: clinical, patient, patient-clinician relationship, clinician, and health care setting and technology.
The panel members drew on existing literature and their own expertise to draft sections examining the effect of each domain’s component factors on the appropriateness of telehealth use. The panel assessed appropriateness through the context of the six Institute of Medicine aims for health care quality: patient-centeredness, equity, safety, effectiveness, timeliness and efficiency.
- Clinical factors: Many studies supported the clinical effectiveness of telehealth for diabetes management, but the panel noted that there are limited data on the effectiveness for other endocrine diagnoses. Therefore, the panel concluded, potential risks and benefits of telehealth to patient safety and health outcomes should be examined in various settings.
- Patient factors: The panel observed geographic distance from the clinic, transportation and work or family obligations as factors influencing a patient’s ability to present for in-person care, which makes telehealth visits a more appealing option. Future research should examine the impact of telehealth on provision of patient-centered care, the panel wrote.
- Patient-clinician relationship: Emotional care can be both facilitated or impeded by telehealth depending on individual circumstances as telehealth may affect the capacity for private conversation, cognitive care, trust, nonverbal communication and shared language. Thus, understanding specific patient preferences is important. Standard measures of the patient-clinician relationship should be identified and used to study how this relationship may be affected over time by telehealth-driven care compared with in-person care.
- Clinician factors: A minority of endocrinologists received formal telehealth training, so clinicians’ digital literacy, experience level and skills in this area vary widely, which may affect the quality of telehealth patient visits. The impacts of telehealth on the clinician workforce must be fully evaluated, according to the panel.
- Health care setting and technology: Practices should consider ease of use for patients using telehealth platforms, which may be influenced by compatibility with mobile operating systems, availability of interpreting services and/or user interfaces in other languages, capacity to connect multiple parties and the ability to grant access. Health systems could benefit from research guiding ongoing and future telehealth investment with priority given to developing and evaluating new hardware and software to improve accessibility and efficacy, structured clinical workflows for telehealth encounters and standardized approaches for delivering team-based care through telehealth.
Clinicians should be encouraged to formulate individualized care plans with their patients by discussing expectations for telehealth in each patient’s care and each clinician’s practice over time while revisiting these plans at each encounter and updating plans based on changes in patient and clinical factors, the panel wrote.
“We espouse the need for ongoing research that explores processes and outcomes associated with high-quality endocrine care via telehealth across a variety of conditions and practice settings,” the panel wrote. “Accomplishing this research will require financial and philosophical support from funding organizations and professional societies and will provide the foundation for future evidence-based guidelines for telehealth use.”
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