The rollout of telehealth during the coronavirus pandemic has been one of the few positives of the crisis, but it remains to be seen whether the almost wholesale switch to video consultations will remain after the pandemic eases.

New research from the University of California, San Francisco, suggests it will become a permanent feature for some healthcare providers.  The paper highlights how patients at the UCSF Adolescent and Young Adult Clinic shifted wholesale to videoconferencing during the pandemic.

The clinic serves a wide range of patients, aged between 12 and 25, with roughly 75% of them female.  It provides both general and specialty health care in a wide range of issues, including sexual and reproductive health, addictions, and attention disorders.

Video consultations

The researchers used a telehealth platform that placed patients into a virtual waiting room, before being approved for entry into the consultation by the doctor.  Each consultation was streamed and not recorded.  They also provided means by which information could be shared securely and discreetly.

“The telehealth visit is a new reality and one that presents unique challenges,” the researchers say. “While you can see the patient’s face, you cannot make direct eye-contact and you cannot demonstrate compassion by offering a tissue or a gentle pat on the arm. I found it meant that I had to exaggerate facial expressions or offer more verbal assurance than I would have done in actual visits.”

The results suggest that the virtual format of the consultations presented no barriers to robust consultations being performed, with the clinicians able to perform their full range of tasks.   The only real challenges were with appointments that required exams or procedures, as it’s obviously difficult to provide a vaccine or conduct tests for urinary tract infections remotely, although the team accept that a range of connected devices could allow for various procedures to be undertaken remotely.

Weighing in

Around a third of the patients cared for at the clinic have eating disorders, and significant workarounds were required to continue serving them adequately.  For instance, the team say that weight checks can be stressful for many patients, who often prefer not to know their weight.  In some instances, primary care providers were able to perform the weight checks, and then share the data with the clinic, whilst in other instances, a trusted adult was tasked with doing the weighing.

“There were concerns that patients would overhear their weight or learn of nutritional interventions that normally parents would discuss confidentially with the physician during an in-person appointment,” the researchers say. “But on the upside, many families travel significant distances to reach us. Telemedicine may have allowed for increased parental participation.”

Overall, however, the shift to telemedicine provided a boost not only to the accessibility of their service, but also the ability to collaborate effectively with primary care providers.  It’s a level of success that the team believe will make the shift a permanent one.

“There’s a sense that many of the changes are not just temporary responses, but rather the new normal,” they conclude. “We are not proposing that telemedicine for adolescents and young adults will replace in-person visits, but we can look at this quick shift as an opportunity to reach our patient population in new ways, both in this time of crisis and beyond.”