Where and how people receive care has shifted dramatically in the USA since the Affordable Care Act (ACA) was passed in 2010. People are turning to online, phone or video based visits with their care teams as new ways to receive care. The upside is they can weave the visits into their day without having to take time off to travel to medical offices. Optimal use of video visits is still emerging, some care will always require hands-on healing by care teams, but video visits is an emerging healthcare trend. Telemedicine, in general, has many applications in the delivery of modern healthcare.
A new study by Linda Sturesson from the Karolinska Institutet in Sweden published in the Journal of Medical Internet Research examined the selection criteria for video visits in outpatient care for patients with obesity. Evidence shows that video-visits can be as effective as face-to-face visits in care in the outpatient setting. Challenges remain in implementation as workflows and day to day clinic management also need to be taken into consideration. Trust is a crucial element of care delivery and an essential aspect of healing. Video-visits need to bridge the gap to ensure trust is maintained in the healing relationship. On the technological level, patients also need to be in a place that supports fidelity to render a good quality video experience. Video visits do, however, add another element to the clinician’s to-do list- which patients are suitable for that kind of visit? Clinicians have to consider patient preference, the complexity of the reason for the visit, their comfort with the technology necessary to deliver video visits and added to that the fact that patient satisfaction, and attitudes are influenced by the physical clinical environment, so the context of video needs to take this complexity into account.
Criteria for Video Visits
The study wanted to shed light on the criteria for video visits and included 13 observations of video visits at two different clinics and included fourteen follow up interviews with clinicians. Three broad themes emerged in selecting patients for video visits. Patient ability, meeting content, and practicalities. Issues raised included patient acceptance of video visits, their access to technology and if they had a prior face to face visit with their clinician. Clinicians consider how far the patients live from the clinic, if patients experience economic hardships in attending clinic visits or if they have family or work obligations that would make it hard to participate in clinic-based care.
Regarding obesity treatment, clinicians would choose video-visits if the patient was at a stable weight, didn’t have any mental health issues or complex co-morbid conditions. They were also more likely to chose video visits if they already had a relationship with the patient. Visit cadence was also crucial if the patient and clinician felt more frequent visits were warranted and if a video was a superior method of communication for a visit versus email or phone calls. Other enablers also included whether sensitive issues were not likely to be discussed.
Video visits are becoming more frequent as part of the fabric of clinical care delivery. Much work remains on which patients are best suited to this medium and clinicians have to develop new workflows and selection criteria to make this viable. Where video visits best fit for obesity care is still a work in progress but an essential evolution in ensuring enough touchpoints between patients and clinicians given the many Grade B recommendations from the US Preventive Services Task Force (USPSTF) regarding the treatment of Obesity. Three recommendations support risk reduction efforts in obesity, diabetes and cardiovascular disease- all of which have weight loss as a cornerstone to reduce risk. Healthcare continues to go through tremendous disruption and new models of care emerging. We will keep our eye on what emerges for video.
Thanks for reading – Trina
(Opinions are my own)
Clinicians’ Selection Criteria for Video Visits in Outpatient Care: Qualitative Study