{"id":28929,"date":"2020-09-11T19:32:47","date_gmt":"2020-09-11T19:32:47","guid":{"rendered":"https:\/\/dev.mtelehealth.com\/?p=28929"},"modified":"2020-09-11T19:32:47","modified_gmt":"2020-09-11T19:32:47","slug":"telehealth-works-how-well-depends-on-a-few-factors","status":"publish","type":"post","link":"https:\/\/drmiltie.com\/at-home-testing\/telehealth-works-how-well-depends-on-a-few-factors\/","title":{"rendered":"Telehealth Works. How Well Depends On A Few Factors"},"content":{"rendered":"\n

Covid-19 has seen a massive increase in the use of telemedicine. While it may seem novel, it\u2019s actually been around for decades and research shows it\u2019s frequently just as effective as face-to-face interventions, if not better. But how well it works for you mostly depends on your healthcare system.<\/p>\n\n\n\n

When it comes to telemedicine, we already know what we\u2019re doing<\/h2>\n\n\n\n

Telemedicine has been around for decades, but it never really took off in the way you might expect\u2014that is, until now<\/a>.<\/p>\n\n\n\n

\u201cThis has been a real-world experiment, if you like,\u201d says health economics and policy expert Nkiru Eze.<\/p>\n\n\n\n

\u201cAll the barriers that we were facing previously, it\u2019s almost<\/em> as if they\u2019ve melted away because we\u2019ve had no other option but to access remote care.\u201d<\/p>\n\n\n\n

Ms Eze has just published an umbrella review of telemedicine in the OECD<\/a>, identifying what the state of play was before Covid-19 in terms of clinical and cost-effectiveness, patient experience, and implementation of telehealth.<\/p>\n\n\n\n

What her team found was that although not all healthcare can be delivered remotely, telemedicine has mostly been as effective as normal care and, in some cases, better.<\/p>\n\n\n\n

Telehealth diabetes management, for example, was reported to have better than or comparable results to face-to-face interventions.<\/p>\n\n\n\n

When it came to cardiovascular disease, remote monitoring and phone support were \u201csuperior to usual care in reducing the odds of mortality and hospitalization related to heart failure, improve survival rates and reduce cardiovascular disease risk factors such as weight, BMI and blood pressure.\u201d<\/p>\n\n\n\n

Telemedicine has helped manage pain effectively and increase exercise levels, improved mental health and diet, and aided in the control of respiratory diseases like asthma.<\/p>\n\n\n\n

And, according to studies, people like using it (patients more so than health practitioners), whether it takes the form of mobile apps, remote monitoring, online support, or picking up the phone.<\/p>\n\n\n\n

Healthcare is not like other markets<\/h2>\n\n\n\n

So, if the reviews have been so good, why haven\u2019t we taken it up in greater numbers before now? Other industries have been transformed by remote service provision. Why not primary healthcare?<\/p>\n\n\n\n

\u201cIf you look at it from a health economics perspective, the healthcare market is different,\u201d says Ms Eze.<\/p>\n\n\n\n

\u201cThat\u2019s part of the reason why it\u2019s not been implemented at the scale that you think it would be.<\/p>\n\n\n\n

\u201cIt\u2019s not as easy as saying, for example, because we used to shop in stores before and now online shopping has come, most people are going to move online. Healthcare is not really the same.\u201d<\/p>\n\n\n\n

For one thing, it\u2019s generally not discretionary.<\/p>\n\n\n\n

\u201cThere\u2019s things like inelasticity of demand. If you were sick, you\u2019d literally pay anything to get better. So there are no real alternatives,\u201d explains Ms Eze.<\/p>\n\n\n\n

\u201cIf you\u2019re on a budget you can either buy butter or vegetable spread, which is cheaper. But in most cases for healthcare there\u2019s not that option for you to choose. And even if there were, you wouldn\u2019t know what drug to choose instead of another. You don\u2019t have all the information.\u201d<\/p>\n\n\n\n

Success comes down to the healthcare system where you live<\/h2>\n\n\n\n

When you look at what\u2019s happened with telehealth around the world, Ms Eze says it\u2019s not about who does it better.<\/p>\n\n\n\n

\u201cI wouldn\u2019t use the word \u2018better\u2019,\u201d she says.<\/p>\n\n\n\n

\u201cIt has to do with policy, with the reimbursement models. It\u2019s the way that healthcare systems are set up.\u201d<\/p>\n\n\n\n

Canada, for instance, has recently implemented new policies to reimburse doctors for telemedicine.<\/p>\n\n\n\n

\u201cReimbursement was the biggest barrier. Telemedicine takes as much time as face-to-face. Sometimes it could take longer. And time is money. So if you\u2019re not reimbursing for telemedicine there wouldn\u2019t be that much uptake for it, or else doctors are providing healthcare for free,\u201d Ms Eze explains.<\/p>\n\n\n\n

She says the fee-for-service model of healthcare provides more of a challenge for telehealth than, say, a salary structure.<\/p>\n\n\n\n

\u201cIt comes down to your healthcare system and what policies are in place. So if the policy makers want it to work, then you need to give doctors incentive to provide telemedicine.\u201d<\/p>\n\n\n\n

And then there are the barriers faced by patients. While technology is cheaper and more advanced than it\u2019s ever been, it still costs a significant amount of money to buy equipment\u2014even just a smart phone, which is often the bare minimum\u2014and pay for internet. People also need access to appropriate training and support.<\/p>\n\n\n\n

\u201cThe people most likely to benefit are those who are normally marginalized from accessing face-to-face care: people who live in remote areas, people that are disabled, those who are house-bound, some older adults, those who don\u2019t have transport and so on,\u201d says Ms Eze.<\/p>\n\n\n\n

But she says these are the people telemedicine is less likely to reach.<\/p>\n\n\n\n

\u201cThat\u2019s who interventions should be targeted to when everything normalizes. It\u2019s a bit of a paradox. Telemedicine is more likely to reach those who are tech savvy and who live in urban areas.\u201d<\/p>\n\n\n\n

It\u2019s equitable now and cost-effective in the long term<\/h2>\n\n\n\n

Ms Eze explains that providing telehealth to rural areas, for instance, may not appear cost-effective in the short term, but will provide a long-term economic benefit.<\/p>\n\n\n\n

\u201cYou\u2019re averting a worsening of their condition,\u201d she says. \u201cIf you look at the long-term horizon, it\u2019s potentially cost-effective when you look at the hospitalizations that you\u2019re going to avoid by intervening early.<\/p>\n\n\n\n

\u201cYou will reap the benefits in 10 or 20 years\u2019 time.<\/p>\n\n\n\n

\u201cAnd it\u2019s like any other intervention. [You have to] to put those cost controls measures in place to make sure the costs don\u2019t spiral out of control.\u201d<\/p>\n\n\n\n

Ms Eze believes telehealth is here to stay.<\/p>\n\n\n\n

\u201cI know a lot of healthcare systems are looking at their reimbursement models again and thinking about how we can deliver care remotely. And I think it will be the future, definitely.\u201d<\/p>\n\n\n\n

\u201cBut I don\u2019t have a glass ball,\u201d she laughs. \u201cSo, I don\u2019t know.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"

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While it may seem […]<\/p>\n","protected":false},"author":3,"featured_media":28930,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_uag_custom_page_level_css":"","_uf_show_specific_survey":0,"_uf_disable_surveys":false,"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[14,189,141,159,165],"tags":[],"class_list":["post-28929","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-blog","category-covid-19-coronavirus","category-reimbursement","category-telehealth","category-telemedicine"],"acf":[],"yoast_head":"\nTelehealth Works. 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