Telehealth As an Option, Not a Requirement-Who May Benefit, and How Do We Decide?

Abstract

During the COVID pandemic, telehealth has been established as a feasible form of treatment that is at times preferred by both clinicians and older adult patients. As the height of the pandemic fades, yet remains part of everyday life, care has shifted in many practices from primarily video and phone visits (telemental health, or TMH) to a hybrid model that includes both virtual and in person visits. There are both advantages and potential drawbacks to TMH. Advantages include the ability to see patients who are otherwise homebound or find transportation difficult, the ability to see patients without a mask, reduction in no show rate, the potential to get a sense of the patient's home environment, and actively involving family whom the patient would like to include. Potential drawbacks include a loss of aspects of non-verbal communication, inability to perform a physical exam if needed (for example, to assess gait, check or vitals, or evaluate for extrapyramidal symptoms), potential lack of privacy, and a patient's difficulty navigating technology. Clinician related factors may also affect the success of telemental health as a treatment modality. These factors include personal preference, clinicians’ comfort with technology and the suitability of a provider's work environment for this platform. The frame of treatment (medication management versus psychotherapy) is an additional factor that must be considered. There are also individual patient characteristics that may contribute to them being more or less receptive to this modality of treatment. These factors will be highlighted in case examples in the session. Now that clinicians have a choice about meeting virtually or in person, it will be helpful to have a framework for making this decision. In this workshop, we will present guidelines for evaluating the usefulness of video delivered treatment. We will propose factors to be considered by clinicians to evaluate an individual patient's suitability for tele health versus in person or a hybrid model. We will also discuss strategies to overcome potential barriers.