Research confirms patients embrace telehealth services during pandemic

Nov 2020

During the national lockdown in New Zealand, the rise in telehealth dramatically spiked as doctors changed the way they operate to meet strict safety requirements. Patient contact, which has remained as it has been for decades, were taking place via virtual consultations in a matter of days in a bid to eliminate the risk of exposure to patients and staff. A recent research report reveals that many patients are pleased with their telehealth experience and surprisingly, have adapted quickly.  

What was once overlooked, underdeveloped and unfamiliar, telehealth is now the revolution in healthcare as COVID-19 activates a global health emergency. With the potential for telehealth services to meet increasing demand for healthcare by improving efficiency and quality of care, it also means being able to eliminate some of the challenges in the traditional doctor-patient journey.

The survey, completed by researchers from the Health Services Research Centre, Victoria University of Wellington and Otago University, Wellington was undertaken in March-May 2020 during the national lockdown and had 1010 respondents.

The report reveals that patients are keen and willing to try telephone and video consultations and emphasised the need for practice staff to be skilled in active listening and building empathy. It was also important for practice staff to stay calm and kind when communicating with patients during stressful times to ensure they are not put off seeking help.

Of the 1010 patients surveyed, 61% of those patients who had a telephone consult during lockdown were asked whether they had had a telephone consult before lockdown – 82% said they had not. Only a small proportion had a video consult (5% of those who contacted primary care during lockdown) – 94% had not previously experienced a video consult.

“Several respondents commented on how a video consult was much like an in-person visit. People were generally willing to give it (telehealth) a go, especially in lockdown when lots of people were trying out Zoom and other video platforms to connect with friends and family,” Fiona Imlach, Lead Researcher says.

The report suggests that telehealth services have the potential to support a significant number of people with an increase in better healthcare outcomes – although practices need to be proactive in reaching out to patients to inform them of any significant changes and tell them what they can expect. There is an emphasis on continuing to build on their patient relationships via online services, which will help to ensure the success of telehealth methods.

Telehealth ticks many boxes for patients including eradicating the time spent travelling to and from the doctor’s office, allowing them to obtain doctor’s advice remotely and receive prescriptions, as well as avoiding long waiting times. Patients can even skip waiting rooms altogether, which is appropriate considering this is where germs can linger, and therefore allows them to responsibly look after their health and the health of others.

“From this research, patients want choice and the option of the type of consult that matches their needs and circumstances and health issue of the moment,” she says. “Some things that could facilitate that would be to ask all patients about their preferences for engaging in telehealth, and don’t assume that older people don’t want the option, and provide technical support for those who would like to try it or might benefit from trying it.

“It would also be useful for patients and practices to both have access to clear guidelines on when telehealth is appropriate and when it isn’t at the initial appointment set-up; and what to do when it isn’t working or when you need to convert from one method to another.”

“Related to this, several respondents had strong opinions about triaging done by reception staff – they felt this was unsafe, inappropriate and would not be happy about having decisions about telehealth being made by non-health professionals,” she adds.

“Ensuring telehealth consultations are right for both patients and providers is essential for providing the correct service for their care. This starts from the very first interaction, when patients speak to administration staff. The administration staff are not clinically triaging but have been trained to ensure patients access the appropriate care through the right modality, so that if an in-person consult is required then this is booked instead of a telehealth appointment and vice versa,” Dr Kim Hurst, GP Owner Silverstream Health Centre and Te Awakairangi Health Network Clinical Director says.

“Over the last few months, we as General Practice teams have had to quickly adapt to a changing environment with a global pandemic and it has been a steep learning curve. With this many of our teams have had training to ensure telehealth consultations are right for both patients and providers to ensure we are delivering the appropriate level of care. Triage done by clinicians certainly helps to guide the patient. There will always be a need for examination in making diagnosis but in some cases, it isn't necessary for follow-up appointments or the problem doesn't require hands-on. When it becomes apparent that an examination is necessary the history taking can streamline the patient's journey through the clinic. It is also important we ensure an equitable approach to telehealth making sure everyone has the opportunity to have access to convenient care. The more we can guide our patients on what is appropriate for telehealth consultations the more efficient and effective they will be,” Dr Kirsty Lennon, Clinical Lead at Health Care Home National Collaborative says.

The Government responded to the escalating situation quickly – dedicating $50 million in support for GPs and primary care as part of a $500 million fund to strengthen health services to fight and contain COVID-19. The Ministry of Health also released a new rule which makes it easier for prescriptions to be prescribed electronically without the need for signatures. This support for virtual care to help healthcare ramp up their offerings has been essential in alleviating challenges in a unique climate.

From the patient survey, Fiona notes “Lots of respondents talked about experiences of e-prescribing – this didn’t go very well at the beginning for some people, as systems struggled to cope with the disruption and change, but most people loved the convenience of not having to pick up a script from the clinic.”

With New Zealand experiencing a second wave of Coronavirus cases, as well as a spike in cases in other countries which also had the virus nipped in the bud from the outset, sustained use of telehealth means primary care will be able to assess and treat remote patients while maintaining social distancing rules.

When asked if telehealth will be sustained in New Zealand after the crisis is ‘over’, Fiona responded “We hope so. We hope that patients who had a positive experience of telehealth consults during lockdown will request these options and increase demand for these services, now they have seen how they can work.”

What is clear is that there needs to be investment in telehealth to increase access to healthcare for patients who may otherwise struggle, even under pre-Covid times. “Even though the consult may be quicker and more convenient for the patient, it might not take less time for the provider. If funders truly want to see a patient-centred service, as is an aim of all the national health strategy documents, then they need to be willing to fund telehealth services.”

Most of the survey respondents wanted their clinic or health centre to offer telehealth services in the future. 80% of survey respondents wanted telephone consults, 69% wanted video consults, 91% wanted to be able to order prescriptions online, 93% wanted scripts sent to the pharmacy, 93% wanted to make appointments online, 91% wanted access to their notes through a secure portal and 93% wanted access to test results through a portal.

“The interviews confirmed many of the results of the survey but provided more detail about when and for what people wanted to use telehealth methods. We found that people were generally very discerning about when telehealth was appropriate and when they preferred or needed to be seen in-person. They had a higher level of comfort with telehealth when the issue was known or familiar and when they contacted their usual and trusted health provider.”

Although the pandemic forced the healthcare industry to offer new ways of working as an urgent response to ensure safety, the revolution and wider adoption of telehealth adds a whole new layer of assessment to the traditional doctor’s appointment; and means there is more reason to treat patients using telehealth services – especially if New Zealand continues ongoing lockdowns.

Telehealth has become a gamechanger for the industry and not just for patients who can get help without stepping foot outside their homes, but for doctors too. When you consider how people are living longer and hospitals are redirecting patients to primary care, the idea of being able to safely manage patients using telehealth means the health system in New Zealand could make even bigger strides.

One of the positive aspects of telehealth was the ability to have greater direct communication between the practice staff and the Canterbury District Health Board secondary care consultants. "A major advantage of this collaboration in some clinical cases, was that after the consultation the patient was able to be kept closer to home," Bill Eschenbach, CEO of Waitaha Primary Health says. "This is a benefit that we would be keen to support continuing."

Ryman Healthcare implemented its own electronic care record – the myRyman app, which runs on tablets in each of Ryman’s 3,500 care rooms. It includes video communication apps such as Zoom which enables residents to communicate remotely.

According to a recent survey carried out in America by healthinsurance.com, more than 60% of seniors have embraced technology during the pandemic. Read the full article. This is a positive sign and reinforces the Health Service Research Centre’s research that age isn’t a barrier to telehealth.

“Survey respondents 65 years and older were just as likely to want telephone or video consults in the future as the rest of the sample, and those who had a telephone consult during lockdown had a similarly high level of satisfaction as others,” Fiona says.

Read the summary of key messages from the research here.

Read Health Services Research Centre’s first publication on telehealth – Telehealth Consulatations in General Practice During a Pandemic Lockdown: Survey and Interviews on Patient Experiences and Preferences.

 

Thank you to Fiona Imlach, researcher at Victoria University of Wellington, Health Navigator and the Health Care Home Collaborative for allowing us to share the summarised report alongside this article.

Resources:

• Greenhalgh T, Wherton J, Shaw S, Morrison C. Video Consultations for Covid-19

• Wherton J, Shaw S, Papoutsi C, Seuren L, Greenhalgh T. Guidance on The Introduction And Use Of Video Consultations During COVID-19: Important Lessons From Qualitative Research

• Giles C, Crowe S. Making Remote Consultations Work for Patients During Covid-19: Experience From The “Other Side” Of The Virtual Clinic

• Health Navigator – Telehealth