Doctors without borders: Telemedicine in the age of COVID-19
While the pandemic continues to have a distressing impact on healthcare systems across the globe, telemedicine seems like a good solution for many everyday health concerns. But, when ‘users’ become ‘patients’ does this tech solution hold up?
Recently, while I was having coffee with my brother, he told me he was experiencing a strong toothache. I suggested visiting a dentist (I know, he’s lucky to have me!); instead, he handed me his phone, opened his mouth and asked me to take a photo of the spot that was hurting.
While I’ve been aware of telehealth for some time, this was my first experience of it in action. My brother shared the images of his tooth with a doctor and received a call from her by the time we finished our coffee. I was amazed by the efficiency of the whole process. The doctor diagnosed him with a tooth infection and advised him to book a face-to-face appointment with his local dentist.
Realising the particular benefit that this technology could offer during the pandemic, and sourcing a few more opinions from family and friends, I was keen to explore user experience of telehealth further. This post analyses social media discussions about the topic in order to better understand consumer attitudes and behaviours towards this new healthcare delivery opportunity.
An app to ease pressure on healthcare systems?
At a time when healthcare systems all over the world are at risk of being overwhelmed and people are frightened to visit healthcare facilities in person, telehealth appeared a very efficient way to help healthcare systems cope with the high demand and pressures placed upon them while guaranteeing effective patientcare at a touch of a button.
However, telehealth (“the distribution of health-related services and information via electronic information and telecommunication technologies”) is nothing new. NCBI reported that medical uses of video communications in the US are commonly dated as far back as 1959 [1], but it took a global pandemic for me to see it in action. And apparently, I was not the only one.
COVID-19 accelerated discussions about telehealth
The chart below shows the discussions about telehealth on social in the past 12 months in the UK. (Articles are filtered by keywords “telehealth”, “telemedicine”, “digital healthcare”, “virtual healthcare”, “digital consultations” OR “remote consultations”). In the past year, there have been 57.4K mentions of these topics, with 84% of these occurring after the COVID-19 outbreak in March 2020 (48.4K).
Conversations peaked on the week of March 23rd (3.1K mentions), with top discussions being driven by healthcare practitioners (HCPs) aiming to support the healthcare community in coping with the COVID-19 crises. Mentions included infographics for remote consultations, tips on how to set up telemedicine tools, guidelines and modes for online consultations, as well as virtual courses on how to deliver online therapy.
In the past month, conversations peaked on September 14th after the NHS announced GPs must make sure patients are aware that face-to-face appointments are available when appropriate (1.4K mentions). Despite some discussions from GPs about the risks and consequences of in-person appointments, most discussions that week were focused on HCPs advocating for telemedicine. There were many promotional mentions about doctors joining online events to discuss the opportunities when using telehealth.
Speed of patient receiving care has increased, but is the quality of care reduced?
Overall, sentiment on social about this new healthcare delivery model is favourable. Discussions of this tone are driven by patients sharing the benefits of time-efficient patient care, including personal experiences like reaching their doctor in two hours rather than having to wait two weeks, saving commuting time and money, or avoiding the need to take time off from work for an appointment. Many HCPs were also involved in these positive discussions, mainly by promoting the benefits of these new way of providing healthcare services and sharing their personal professional adoption of these new tools. On the unfavourable side, there is a general concern from some HCPs about not being able to do their job as effectively as in person, with apprehension about safety and accuracy.
Despite HCPs concerns about barriers of virtual consultations, the chart below reveals that change is happening. It includes data from both the NHS patients registered at a GP practice and the online general practitioner consultation platform askmyGP. The graph analyses the absolute change in proportion of consultation types in March, April, May and June 2020 compared to the same months in 2019 [2].
Increase in digital consultation accelerated by COVID-19
There’s a drastic decrease YoY in the number of face-to-face consultations, with these remaining consistently even during post-lockdown months, such as May and June. On the other side, there is an evident increase in remote consultation methods, mainly driven by online messaging and phone calls. The data reveals that these remote methods have persisted even after lockdown periods, showing that Brits appreciate the benefits of using digital tools in primary care.
To go back to my Millennial brother’s toothache for a second: the response from the doctor was speedy; within five minutes he was in touch with a specialist. He was diagnosed with a tooth infection, recommended to take antibiotics and advised to see a doctor face-to-face for monitoring. However, when he went in to get his tooth infection checked, he came back explaining that the dentist diagnosed it as an irritated gum.
Younger generation more forgiving of telehealth limits
After receiving a mistaken diagnosis, I asked him if he had become more sceptical about virtual consultations. He explained to me that these things happen and that’s why you are redirected to an in-person doctor if it is something serious. I was inspired by the trust he has developed in this system after just using it for a couple of months, but at the same time couldn’t stubbornly stop thinking about the misdiagnosis I had just witnessed.
The chart below compared the interest that internet users have in using telehealth services for medical advice related to coronavirus symptoms, as well as their trust in the accuracy of diagnosis of this healthcare delivery method. More interestingly, it also contrasts these statements between those who have tried telemedicine in the past and those who haven’t.
Getting ‘a foot in the door’ on telehealth
Of all Internet users in the UK/ US, 53% are interested in using a telemedicine service for COVID-19 symptoms, with 35% believing that telemedicine diagnosis is accurate. However, those who have previously tried telemedicine services are 13% more likely to be interested in using these services again, with 14% being more likely to trust diagnosis from virtual consultations [3]. This reveals that while interest in trying these new services is high, people who haven’t used them before are notably more sceptical about the accuracy of diagnosis. Whereas those who have tried it first-hand, are more inclined to want to use it again and trust these services. I guess it’s all about getting one foot in the door.
When discussing the virtual dentist experience with my 76-year-old grandmother, it became very clear that she has a totally different view on telehealth. Mainly, she expressed concern about the obstacles of this new healthcare delivery system for her generation.
Age is a barrier to access to digital health
From not having the right phone to download the right app, to frustrating issues with online prescriptions and evident strong scepticism towards diagnosis. Of course, it is not the most surprising reaction for a person of her age to feel threatened by this new digital offering, but digital exclusion stuck with me as a disparity in this new system.
The chart below looks at the top keywords used in telemedicine-related discussions from March to September 2020, which help us understand the way people are discussing this topic in the months following the COVID-19 outbreak. It reveals a general concern about access. Free, public, equal access to digital healthcare services.
Apart from more general terms such as “digital health” or “virtual healthcare”, the visualisation reveals a clear emergence of keywords like “public health”, “rural areas” and “private sector”. These discussions are led by concerns about digital exclusion, whether that is because of age, lack of resources or living areas, with a call for public sectors to support the public healthcare system.
Telehealth removing barriers for mental-health consultations
Another prominent term is “mental health”. Discussions on this topic are led by HCPs, sharing their concerns about the impact of COVID-19 isolation periods on mental health, barriers in delivering accurate assessment and shared guidance about how to provide digital mental health services.
The data above shows mental health as the top driver of telehealth services, with over one in ten people having sought health advice via this method (11%). Other top conditions include migraine, sleep-related conditions and high blood pressure. By April 2020, just a couple of months since the outbreak, both in the UK and US coronavirus symptoms were also among the top conditions, with 8% of users having used telemedicine to seek health advice for these [3].
For all its benefits, there are still some evident drawbacks with telehealth in its current state. It will be worth watching how governments and healthcare regulators address these issues in the future, to ensure telehealth continues to remove barriers to access for all who need it.
References:
[1] https://www.ncbi.nlm.nih.gov/books/NBK45445c
[3] https://blog.globalwebindex.com/trends/coronavirus-revolutionizing-virtual-health
Written by Mila, our Account Coordinator, here