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November 19, 2021 —Telemedicinevisits accounted for more than 60% of patient care at New York community health centers during the peak of theCOVID-19pandemic in spring 2020, finds a new study by researchers atNYU School of Global Public Health.
While video visits have their advantages, telephone visits accounted for a larger proportion of telemedicine care and are critical for providing access and addressing the “digital divide,” according to the studypublished in theJournal of the American Board of Family Medicine.
“Our study suggests that both video and phone visits will continue to shape how health care is delivered in a post-pandemic world,” saidJi Eun Chang, assistant professor of public health policy and management atNYU School of Global Public Healthand the lead author of the study.
The COVID-19 pandemic has catalyzed profound transformations across the healthcare delivery system, including an abrupt shift toward telemedicine. While a significant amount of research has centered on the rapid adoption of telemedicine in the early weeks of the COVID-19 pandemic, less is known about the feasibility, use, and benefits of phone vs. video visits in the months following the widespread transition to remote care, particularly for “safety net” providers who care for vulnerable populations.
Chang and her colleagues tracked the use of telephone, video, and in-person visits across 36 New York community health centers from February to November 2020 and interviewed 25 primary care, behavioral health, and pediatric providers from eight community health centers about their experience with telemedicine during the pandemic.
Both types of visits increased significantly during the first wave of COVID-19 across New York State. At its peak (April 11– May 2, 2020), more than 60% of visits were conducted via telemedicine, the majority of which were provided via telephone. Telemedicine visits tapered off by the beginning of August 2020, accounting for less than 30% of visits. Telephone visits accounted for a larger proportion of telemedicine visits than did video visits throughout the period studied, but the gap narrowed over time.
The health care providers interviewed perceived telemedicine visits to be of similar quality to in-person visits and helpful in reducing no-shows. They also reported that telemedicine improved access to care for patients by providing flexibility; decreasing barriers such as transportation, childcare, and work-related time constraints; and reducing stigma surrounding mental health services.
Video telemedicine visits are often considered the “gold standard” alternative to face-to-face care because of the ability to see patients, which can provide useful clinical information as well as build rapport and improve patient-provider communication. The providers in the study expressed a strong preference for video visits but acknowledged that they may be exacerbating a “digital divide” between patient populations with more or less access to technology. Specifically, poor Wi-Fi connectivity, a lack of devices with video capabilities, and limited data plans were cited as constraints to successful video visits.
“When it comes to equity in health care access, telemedicine is a double-edged sword,” said Chang.
电话访问有独特的好处，包括更大的私密性、可行性和易用性。医疗服务提供者强调，音频和视频就诊都必须是可报销的，以便医疗服务提供者能够向患者提供持续的支持和护理。
“While the providers generally preferred video, they relied heavily on telephone as a lifeline,” added Chang.
研究参与者还报告了远程医疗的局限性，包括难以进行体检，无法提供疫苗或其他亲自护理。他们提出了改善远程医疗的方法，包括使平台对技术素养较低的患者更友好，将其与电子健康记录集成，并为远程医疗提供财政援助，包括为供应商平台提供资金，为患者提供血压袖带等家庭监控设备，以及培训。
“Despite challenges, providers had positive experiences delivering care remotely using both telephone and video during the COVID-19 pandemic and believe both are critical for enabling access to care in the safety net,” said Chang. “The growth of telemedicine during the pandemic signifies a tectonic shift in health care delivery that is unlikely to be reversed.”
In addition to Chang, study authors include Zoe Lindenfeld and Donna Shelley of NYU School of Global Public Health and Stephanie L. Albert, Rachel Massar, Lorraine Kwok, Kayla Fennelly, and Carolyn A. Berry of NYU Grossman School of Medicine. The research was supported by the RCHN Community Health Foundation.
About the NYU School of Global Public Health
At the NYU School of Global Public Health (NYU GPH), we are preparing the next generation of public health pioneers with the critical thinking skills, acumen, and entrepreneurial approaches necessary to reinvent the public health paradigm. Devoted to employing a nontraditional, interdisciplinary model, NYU GPH aims to improve health worldwide through a unique blend of global public health studies, research, and practice. The school is located in the heart of New York City and extends to NYU's global network on six continents. Innovation is at the core of our ambitious approach, thinking and teaching.
For more information:http://publichealth.nyu.edu/
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