Telehealth proves to be a boon for cancer and diabetes care

by The Insights

Like many people, I was introduced to telehealth during the pandemic. I met my psychiatrist virtually, settling on my couch instead of his for our sessions. But these appointments only required a conversation. It made sense that psychotherapy would move easily into the online world.

What’s more surprising is how often telehealth is now being used in other medical fields, such as cancer care. Although chemotherapy and immunotherapy are usually done in person, follow-up visits and medication and symptom management can be done virtually, says Leah Rosengaus, director of digital health at Stanford Health Care in California, where 44% oncology visits are virtual. For cancer patients receiving routine treatment, this equates to a lot less hassle. And for a patient with a poor prognosis, it could be even more significant. “The greatest gift [we can] give them time,” says Rosengaus.

Telehealth programs accounted for less than 1% of all healthcare in the United States until March 2020, when, of course, that all changed. The pandemic has limited personal contact and telehealth has increased. (At Stanford, it went from less than 2% to more than 70% of visits in just a few weeks.) State and federal regulators relaxed rules that required doctors to see patients personally before providing care, and insurers have started covering virtual visits. Now, the use of technologies such as video chats, secure messaging, and even old-fashioned phone calls to allow clinicians and patients to communicate seems to be here to stay. It has settled at 10 to 30 percent of patient appointments in many large hospital systems.

In general, the quality of telehealth care appears to be high. Almost 87% of the time, Mayo Clinic researchers reported in JAMA Open network last fall, a first virtual diagnosis in agreement with a later diagnosis carried out in person. Oncology and psychiatry proved particularly accurate; otolaryngology and dermatology appointments—which rely more on physical exams—were a little less so. A 2022 study of more than 500,000 patients found equal or better outcomes for telehealth in 13 of 16 primary care measures, such as diabetes management and flu shot appointment tracking, per compared to in-person visits.

The results in terms of quality of care seem to be the highest in the specialties that use telehealth the most. Endocrinologists, for example, love it because their patients perform lab work separately and then virtually discuss the results with doctors; surgeons use it to talk to patients before and after procedures.

Patient satisfaction with these visits is good, according to reports from major health care systems. People say they love the convenience of virtual care – there’s no commuting, no parking, no child or pet care to arrange. Sanford Health, which serves a large rural population from its base in Sioux Falls, SD, estimates that its patients who used virtual care were saved two and a half million driving miles in 2022.

In some cases, technology allows clinicians to better understand the people they care for. Jeremy Cauwels, chief medical officer at Sanford, says an endocrinologist with his organization now spends several hours a week doing video visits with diabetes patients after discovering how much information about diet and habits he could glean by observing them at home.

People vary in how much of their home life they’re willing to show, of course. While some patients would never turn on a camera in the living room, others happily flaunt the inside of their medicine cabinet or refrigerator. “We get a window into the patient’s living environment that we never had before,” says Rosengaus. “It reminds us of the days of doctors and home visits.”

Virtual tours don’t work for everything and everyone. In the large 2022 telehealth study, office patients were more likely to receive and adhere to certain medications, such as statins for cardiovascular disease. Starting “lifetime medication” is an important decision that might be better suited to an in-person discussion, the authors suggest. Another study found that patients who completed an emergency hospital visit via telehealth rather than in person were more likely to be readmitted to hospital.

Obviously, medical providers need to refine the best use of this technology. The rest of us will continue to find our comfort level (I draw the line by pointing to my medicine cabinet). The goal, proponents say, is not just to increase the use of telehealth, but to optimize it and create a good form of hybrid care they call “clicks and mortar.”

This is an opinion and analytical article, and the opinions expressed by the author or authors are not necessarily those of American scientist.

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