Telemedicine may have a role in primary care

It is usually a Saturday evening when I get a telephone call from a patient. The majority of the time, it is a simple medical question to clarify their medication, inform me of their blood pressure, or to ask when they should come in to see me again.

Other times it is to ask my medical advice about their current illness, such as a cold or a rash. It seems that these calls always happen when I am not at home or within distance of their medical records. My thoughts are usually: “You need to be seen, we need an office visit.” Yet, this doesn’t happen, due to waiting weeks for an office visit, convenience and cost.

A possible solution to this problem is to schedule a virtual visit, where patients can talk and see their provider through the computer. Patients already schedule appointments online, review their lab tests, and also send their providers messages through their portal electronically. Telemedicine is a solution for access, especially for patients who live in rural areas and travel long distances to see their provider.

In primary care it can be used for non-emergency problems w, when patients wnat their provider’s advice but don’t necessarily need to be seen right away. A telephone call or videoconference doesn’t replace the face-to-face encounter; it can enrich the doctor/patient relationship.

In a recent Modern Healthcare article, it mentions that patients living in rural areas with access to primary care providers through telemedicine have increased quality of care and reduces costs by reducing readmissions and unnecessary emergency department visits. Making care more easily accessible to rural patients without long travel itself can improve outcomes.

Due to travel costs and lack of social support, patients in rural areas will often forgo their medical care. The farther patients need to travel for care, the more likely they are to put off medical appointments. While most patients accept that they will need to travel to a larger city for specialty care such a cancer treatment or a cardiac procedure, they are less willing to do so for routine services such as followup for blood pressure or diabetes. Providing health care through virtual visits is one way to overcome some of these barriers.

There are multiple challenges that need to be overcome for telemedicine in primary care to be successful and effective. We need to keep in mind that not everyone has computer access, and we should be cognizant that this disparity exists. Telehealth is also limited by the speed, quality and availability of Internet connections in underserved areas.

Certainly, data privacy is of utmost importance, and technology must be compliant with the Health Insurance Portability and Accountability Act. Telemedicine is a HIPAA-compliant method for patient appointments, and online video appointments must be conducted via a HIPAA-compliant telemedicine platform.

Patients and health care providers have a lot to gain from online video appointments. The right technology can be highly effective and appropriate for followup care and routine appointments once a provider-patient relationship is established in person.

A significant factor that enables virtual visits in primary care to be successful is the opportunity to sustain an established relationship. It gives my patients a chance to ask questions that were thought of after they left the office, and gives me a chance to check up on their progress.

As a busy working individual, I usually have to schedule my doctor visits early in the morning or late evenings after work. The convenience of the virtual visit appeals to busy patients like myself who often do not have time to come to the office.

Patients can speak with providers about their blood pressure targets without losing time from work. Breaking down barriers such as cost, convenience and time enables patients to “see” their primary care providers instead of delaying care, which often occurs in rural areas. Telehealth can play a very big role in extending that followup and nourishing an established patient/doctor relationship, thus increasing trust and improving quality of care.

Dr. Lan Nguyen, a primary care physician practicing in Olympia, is a member of The Olympian's 2016 Board of Contributors. She may be reached via drlnguyen@gmail.com.