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Q&A: What it's like to deliver care—and empathy—to Covid-19 patients via telehealth

April 16, 2020

    Telehealth is key to preserving capacity and productivity for clinicians. Unfortunately, that operational focus can feed a common narrative that virtual care does not allow patients and providers to have meaningful interactions.

    Cheat sheet: 3 imperatives to leverage telehealth against Covid-19

    Studies of patient experience with virtual care undermine that no-connection narrative. In one Harvard Business Review case study of video-based visits at Brigham and Women's Hospital, nearly three-quarters of patients said virtual interactions improved their relationship with their provider. Even so, limited overall use of telehealth before Covid-19 has provided few opportunities to dispel this misperception.

    As providers consider potential shifts to delivering more care delivery virtually, they'll need to think about how best to establish meaningful connections with patients when they're not actually in the same room.

    To hear firsthand from a provider with a long history of providing remote care, Advisory Board's John League recently spoke with Josep Picas, a retired physician who previously served as Head of Primary Care for the city of Barcelona, Spain. Picas has volunteered to provide remote check-ins with patients who have used Barcelona's symptom-checking app and report mild Covid-like symptoms, and he shares how providers can establish meaningful connections with patients when they're not actually in the same room.

    Question: Josep, thank you so much for speaking with me. I'd like to start off by hearing more about Barcelona's symptom-checking app. Can you describe the process patients go through to get connected to a physician to evaluate them for Covid-19?

    Josep Picas: The Catalan region developed an app that incorporates algorithms to analyze patients' symptoms. The patient fills out a questionnaire that asks them about their symptoms. Based on the patient's responses, the app recommends one of four options. It tells patients "not to worry," or if they say they have cough or fever, they are prompted to either: Speak with a volunteer doctor within 24 hours about their health and social situation; Get follow-up from primary care; or Call emergency services to bring them to the hospital.

    The volunteer doctors like me receive a list every morning with a list of calls that we will have to complete that day. Now, I'm getting about five per day, but in the beginning I had 15 to 20. Originally, we were getting a spreadsheet of names and phone numbers, but now we are getting data from the patient questionnaires in the app. I can see symptomatology, fever, some declared pathologies of the patients, and previous comments of my colleagues. We can now also make a direct referral to the primary care information system for additional telephone follow-up from the patient’s assigned GP.

    Q: And how many patients would you estimate are showing Covid-19 symptoms?

    Picas: I'd say more than 80% of the patients I speak to are symptomatic of Covid. They're either experiencing shortness of breath or other mild symptoms. They might normally get checked out at the hospital instead of talking to me, but with mild symptoms they wouldn't be admitted.

    Q: Are patients comfortable using the app?

    Picas: For the ones I've spoken to, tech-savviness is not a problem. Family members are also helping patients use the app. In some regions, the app also helps the patients contact a primary care doctor over phone or a dedicated email.

    Q: How do patients feel about interacting with a physician this way?

    Picas: It's an interesting experience. We talk for about 10-15 minutes per patient, trying to understand the situation. If they are at the beginning of serious symptoms of Covid, we'll help them navigate to primary care or ED. With the data we now get from the patient questionnaires, we can have more personable conversations. We are more informed to make decisions and recommendations.

    It's important for doctors to employ empathy. We have more time to talk to each patient: they can explain their feelings, we can make them feel more comfortable with the idea of a phone consult, and with their condition. Patients have been talking about their family lives, and we are able to advise whole families. Patients have been sincerely thanking us at the end of every interaction.

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    Q: What's the hardest part for a physician about providing services this way?

    Picas: If I decide that the patient should go straight to the hospital, I have a hotline to call emergency services to pick them up—not that I've had to use it yet—but as a physician, it's hard to decide if it's better if emergency services calls the patient in a few hours to check in, or just comes to take them away immediately.

    We have protocols that say, for example, when we should recommend a chest x-ray in an ambulatory facility to discard the possibility of pneumonia or pneumonitis. There are three or four critical points to make decisions like these, and each morning before beginning to make our calls, we review the latest updates to the protocols.

    Q: What else should we know about primary care during COVID-19?

    Picas: Primary care is full worldwide, but it’s pretty heterogeneous in terms of care received. Some doctors have times to call patients at home to follow up, and some don’t. We are able to ask our patients how their relationships are with their primary care doctors, and encourage them to keep in touch—or change to a primary care doctor that will be more attentive.

    How Covid-19 is transforming telehealth—now and in the future

    Covid-19 has transformed telehealth from a “nice-to-have” program into an essential element of care delivery. Parallel demands to limit patient travel, prevent potential exposure, and preserve clinical capacity all have telehealth as a solution.

    The sudden attention from providers, payers, and consumers will also have enormous consequences for telehealth adoption in the future.

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