Over the past few months, an increasing number of studies have discussed the merits of telemedicine over face-to-face consultations in a variety of disease areas. It seems that the sharp rise in telemedicine services provided over the course of the COVID-19 pandemic has unearthed much-needed soul-searching on the best way forward to improve the patient experience.
In almost every aspect of patient care, physicians are seeing new opportunities that telemedicine can provide. This is a conversation worth having, since we know many patients may feel more comfortable convalescing in a nonclinical setting, which may seem foreign and sterile.
It was once the unspoken consensus that the engagement of too much technology in clinical practice is fraught with dangers; for example, some physicians fear its implications on patient confidentiality, data protection, and legal repercussions should something be amiss. However, the tide is decisively turning as we increasingly contemplate living in a world that is heavily digitized.
Evolving Views on Telemedicine
To trace the evolution of thinking surrounding telemedicine over the years, we refer to a systematic review of the effectiveness of telemedicine written in 2010. Although Ekeland and colleagues adopted a positive tone in describing the rise of telemedicine in the review, they also were more cautious about its potential downsides.
On the promise of telemedicine, they wrote “There is potential for using Internet/web-based services for cancer patients in rural areas, and telemonitoring can empower patients with chronic conditions.” However, in the next section, they cautioned that “the evidence for the effectiveness of telemedicine is still limited and inconsistent, across a wide range of fields.”
In summary, the authors of the systematic review published 12 years ago saw that telemedicine could have widespread uses that could improve patient care, but as with any novelty in medicine, they recommended that more research needed to be carried out to determine for certain the applicability and the effectiveness of telemedicine.
“Despite a large number of studies and systematic reviews on the effects of telemedicine, high quality evidence to inform policy decisions on how best to use telemedicine in healthcare is still lacking,” they wrote. “Large studies with rigorous designs are needed to get better evidence on the effects of telemedicine interventions on health, satisfaction with care and costs.”
Telemedicine and Cystic Fibrosis
Now we turn our attention to a study written by Dixon and colleagues in 2021 titled “Telemedicine and cystic fibrosis: Do we still need face-to-face clinics?”
In their study, Dixon et al made a forceful and rather convincing argument about how telemedicine can improve care for patients with cystic fibrosis. Importantly, their findings are the result of a compilation of views from multidisciplinary team members at a large medical center that treats pediatric cystic fibrosis.
Read more about cystic fibrosis etiology
The authors of the study also wrote about the speed at which telemedicine is gaining attention in the medical world. They reported that based on their literature review, among the 74 titles recovered in PubMed with the term “cystic fibrosis” and “telemedicine” or “telehealth,” 30% of them were published in 2020. This means that evidence for or against it is accruing at a steady pace.
Dixon and colleagues described what they have managed to achieve in cystic fibrosis care with telemedicine. First, they reported that the majority of their interactions with cystic fibrosis patients over telemedicine were similar to what occurs in a face-to-face consultation. Second, telemedicine allows different members of the multidisciplinary team to monitor patients’ progress in a way that is more convenient to the patient.
Third, clinical reviews can be conducted in a more timely fashion. Dixon et al wrote, “It was suggested that families’ threshold for asking for help might be lower both because they would not have the inconvenience of an in-person visit, but also if they felt they were not ‘bothering’ the team as much.” Fourth, telemedicine allows physicians to tailor the timing of their consultations to the needs of their patients (and parents), thus providing for a more personalized touch.
Read more about cystic fibrosis treatment
There are downsides, of course. The authors of the study wrote about the challenge of patients without access to a home computer or smart technology being unable to access telemedicine services. In addition, they found that in-person consultations were smoother if an interpreter was required. Another problem with telemedicine is that sometimes the patient, being a child, can be absent from the screen, leaving the consultation to his or her parents.
Looking to the Future
It is highly likely that we will be discussing, debating, and fine-tuning aspects of telemedicine in the years to come. With all the potential benefits that it offers, telemedicine is certainly not going anywhere. It will take time for all to adjust to a new mode of healthcare delivery, but the COVID-19 pandemic has demonstrated that both physicians and patients possess the will to adapt if circumstances call for it.
Dorsey and colleagues, in their study on the future of telemedicine, summed up its benefits poignantly: “The advantages [of telemedicine] are . . . accessible care, increased convenience, enhanced comfort, greater confidentiality to patients and families, and now reduced risk of contagion.”
Ekeland AG, Bowes A, Flottorp S. Effectiveness of telemedicine: a systematic review of reviews. Int J Med Inform. 2010;79(11):736-71. doi:10.1016/j.ijmedinf.2010.08.006
Dixon E, Dick K, Ollosson S, et al. Telemedicine and cystic fibrosis: do we still need face-to-face clinics? Paediatr Respir Rev. 2021;S1526-0542(21)00054-3. doi:10.1016/j.prrv.2021.05.002
Dorsey ER, Okun MS, Bloem BR. Care, convenience, comfort, confidentiality, and contagion: the 5 C’s that will shape the future of telemedicine. J Parkinsons Dis. 2020;10(3):893-897. doi:10.3233/JPD-202109