Telehealth provides short-term benefits, but PCPs express concern for long-term damage
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Nearly two-thirds of clinicians reported relying on telehealth during the COVID-19 pandemic to maintain patients’ access to care, according to survey findings from the Larry A. Green Center and the Primary Care Collaborative.
However, clinicians also reported concerns about the continued widespread use of telehealth: 41% of responding clinicians worried that their practice would not be able to support telehealth going forward and 21% said they had to cut back on telehealth use since payments were reduced.
“With no cash infusion and without regard to future payment concerns, primary care tended to the health needs of the nation during the pandemic and continues to do so,” Rebecca Etz, PhD, codirector of the Larry A. Green Center, said in a press release. “Despite poor resources, a shrinking workforce and the growing complexity of health burdens of patients, primary care expanded its services to provide the safety net so many were lacking. When will this nation — and its leaders — wake up to the fact that primary care is key to getting us out of this prolonged pandemic?”
Overall, 1,263 clinicians in 49 states, Washington, D.C. and two U.S. territories responded to the survey between Aug. 13 and Aug. 16. Among them, 72% of respondents worked in family medicine, 13% in internal medicine, 5% in pediatrics, 3% in geriatrics and 7% in another specialty. Also, a majority of respondents worked in a community health center (26%) and a system-owned facility (43%).
Telehealth and the primary care workforce
Clinicians reported that the needs of patients during the pandemic exceeded pre-pandemic levels. In fact, 71% of clinicians said that patient visits were more complex and time-consuming. Meanwhile, 54% were unable to hire staff for open positions in their practice and 45% said they knew colleagues in primary care who had retired early or left their practice due to the pandemic. According to previous research, the U.S. will be short of about 20,000 to 50,000 primary care physicians by 2034.
The survey further showed that 40% of clinicians reported using telehealth for at least one in five office visits. Also, 35% developed new roles in their practice to meet their telehealth needs. Yet, 25% of clinicians were concerned that primary care will become weakened by telehealth in the future whilst the specialty is currently “crumbling,” according to the survey results. Overall, 52% of clinicians rated their pandemic-related strain as severe or near severe and less than 30% described their practices as financially healthy.
Vaccine hesitancy
On the COVID-19 vaccine front, 59% of clinicians had patients who have asked for a third vaccine booster. Also, 34% of clinicians had patients who asked about the vaccine due to fears of the delta variant and 51% reported receiving an adequate supply of vaccines for their patients, yet only 31% said that vaccinating patients was common in their practice. To convince vaccine-hesitant patients to get a COVID-19 vaccine, 52% of clinicians described needing two to three conversations with the patient to change their mind, but 67% believed that most patients’ opinions on vaccines cannot be changed. Also, 57% of clinicians reported having more difficulty convincing newer patients to get the vaccine.
“We are calling upon public and private payers to step up to help meet patients’ needs and safeguard the primary care workforce,” Ann Greiner, president and CEO of the Primary Care Collaborative, said in the press release. “Left with the most difficult-to-vaccinate portion of the population, primary care clinicians must be adequately supported for the multiple conversations that are needed to counter vaccine hesitancy and help meet our country’s vaccine goals.”
References:
A resilient primary care supported patients during summer surge of COVID. https://www.pcpcc.org/2021/10/11/resilient-primary-care-supported-patients-during-summer-surge-covid?language=en. Published Oct. 11, 2021. Accessed Oct. 11, 2021.
Scannell CA, et al. JAMA Netw Open. 2021;doi:10.1001/jamanetworkopen.2021.18836.
Perspective
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Jack Westfall, MD, MPH
Family physicians care for patients in innumerable ways; in-person, by phone, letter, video, and sometimes when they run into each other at the grocery store or a school event. Telehealth has long been part of the family medicine care model, and the COVID-19 pandemic brought this into full view — eliminating many in-person encounters to reduce the risk of viral spread in the office setting.
Suddenly, a patient and their physician were thrust into a world where they had to meet in real time by video or phone. COVID-19 presented us with an opportunity to assess which primary care services can be effectively delivered via telehealth and which cannot. Family physicians are in the best position to engage their patients in a manner that makes the most sense based on the patient’s health care concern, the physician’s medical expertise, the context of the practice and community, and the patient’s risk factors.
While sometimes convenient, direct-to-consumer telemedicine companies are not a viable substitute for an ongoing relationship with a family physician who knows and understands a patient’s personal health history and risk factors throughout their life.
Family physicians will continue to provide excellent care by telehealth, so long as it remains a reasonable and financially viable method to do so. Telehealth should continue to be a service offered by family physicians to patients; however, family physicians have noted challenges that their patients have faced during the COVID-19 pandemic in accessing telehealth services, including not having access to reliable broadband or technology like a smartphone, tablet or computer and not understanding how to use the technology or a specific digital health platform.
The American Academy of Family Physicians (parent organization of the Robert Graham Center) has called for the creation of a pilot program to fund digital health navigators, development of digital health literacy programs and deployment of linguistically appropriate and ADA-accessible digital tools. The AAFP has also called for additional studies of telehealth utilization that collect and analyze data by race, ethnicity, gender identity, language spoken, income and other key demographic factors.
I am encouraged by the success we have witnessed during COVID-19 and hope policymakers will support family physicians’ commitment to meet patients where they are — be that at home, at work, on vacation, or in the doctor’s office — now and beyond the public health emergency.
References:
COVID-19 health care flexibilities: Perspectives, experiences and lessons learned. https://www.aafp.org/dam/AAFP/documents/advocacy/health_it/telehealth/TS-SenateFinanceCmte-DavisTelehealth-051921.pdf. Published May 19, 2021. Accessed Oct. 13, 2021.
Jabbarpour Y, et al. J Am Board Fam Med. 2021;doi:10.3122/jabfm.2021.S1.200247.
Jetty A, et al. J Am Board Fam Med. 2021;doi:10.3122/jabfm.2021.S1.200202.
Ray KN, et al. Pediatrics. 2019;doi:10.1542/peds.2018-2491.
State of Telehealth: Removing barriers to access and improving patient outcomes. https://www.aafp.org/dam/AAFP/documents/advocacy/health_it/telehealth/TS-SenateCommerceCmte-RansoneTelehealth-100721.pdf. Published Oct. 7, 2021. Accessed Oct. 13, 2021.
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