Let Telemedicine Enhance Your Medical Home
We were all thrown into the realm of social distancing, personal protective equipment, and reaching out to our patients through every possible channel available to us in the spring of 2020. Although providers battled with adoption and continue to manage its scope and viability moving ahead, telemedicine quickly became a safe choice for people to get health care. During the coronavirus disease 2019 pandemic, families of children with medical complexity (CMC) encountered even more challenges, balancing the necessity for close medical follow-up for their kid with the risk of virus exposure while entering a medical facility.
Mosquera et al. give us the pre–coronavirus illness 2019 data in this month's Pediatrics to reassure us that adding telemedicine access to an existing complicated care medical home can improve both clinical and financial outcomes. This group of children had all been hospitalised or admitted to a PICU in the previous year and were at high risk of being hospitalised again at the time they were enrolled in the complicated care clinic. Families were assigned to either comprehensive care (experienced primary care physicians, 24/7 phone access, same-day illness care in clinic on weekdays, hospital consult while inpatient) or comprehensive care + audio-video telemedicine access at random. There were fewer days of care outside of the home per child-year at CMC with telemedicine access, lower rates of serious illness, fewer hospital hospitalizations, and fewer PICU admissions. The authors went on to say that setting up and conducting telemedicine sessions cost only $308 per child-year, whereas total health system expenses were reduced by $7563 per child-year.
In normal conditions, we'd all consider the benefits of telemedicine for this high-risk demographic and consider how and when we'd like to incorporate it into our practise. Many practises may have employed telemedicine this year but did not have the time or insight to investigate its impact. We applaud early adopters and innovators like Mosquera et al. providing us with proof to back up our family-centered telemedicine narrative. Primary care physicians and their families had a long time to warm up to telemedicine in this study, with an average of 10 telemedicine visits per month at the start, increasing to 55 visits per month at the end of the trial in March 2020. Given the recent surge in telemedicine use, I am convinced that the rate of acceptance, as well as monthly telemedicine use for CMC, is now significantly higher, resulting in even greater impact. Increases in utilisation can still be cost-effective if tailored medical choices are made by primary care physicians and replace the need for more expensive emergency department visits and/or days of care in a medical setting, as proven in this study and other paediatric telemedicine studies.
Telemedicine in primary care, however, continues to face obstacles. Patients encounter multiple challenges to telehealth access, including a lack of technology, a lack of digital literacy, and a lack of consistent Internet service. The digital divide, which disproportionately affects people of colour, those living in rural regions, and those with low socioeconomic level, is made up of various impediments. Only two of the 209 families randomly assigned to the telemedicine group in this study based in Houston, Texas, lacked the essential technology (smart device + Internet connectivity). We must work with community groups, schools, Internet service providers, and government leaders to eliminate barriers to both technology access and digital literacy as we discover and discuss solutions to the digital divide for disadvantaged communities.
The health of their most vulnerable patients is improved by experienced primary care clinicians who have an existing relationship with CMC and their carers, according to these (and other) studies. Adding telemedicine to their paediatric medical home can further improve that value.
