If you haven’t heard of telemedicine, it’s a pretty simple (if radical) concept: the practice of using telecommunications to provide clinical medical services. This can be over the phone or via Skype-like sessions, either with the patient alone or with the patient’s doctor there, conferring with a specialist. Sometimes electronic testing devices are used, such as Bluetooth stethoscopes, that will relay health information to the doctor on the other end of the call.
An increasing number of insurance companies — and even Medicare and Medicaid plans — are covering the practice as it offers easy access for patients and, probably more importantly for the company, may have lower costs for services rendered.
Telemedicine can be great for all sorts of populations. The most obvious would be people with mobility or transportation issues. Because even if you can get to the doctor’s office, there’s no guarantee that it’s anything approaching convenient.
If you don’t have a car, you’re at the mercy of public transit’s schedule — and routes. There’s a chance you’d need to take multiple buses just to get to the doctor’s office. Then there could be a long wait for the next bus after your appointment is over.
And that’s assuming you can use the bus system. My ex-mother-in-law had to use Dial-A-Ride. The van sometimes ran late. Sometimes it showed up early, before she was completely ready. And she couldn’t schedule her return trip too close to her appointment time, in case the doctor was running late. In other words, a 20-minute (or less) doctor’s appointment was never a quick, let alone simple, proposition.
Even if you do have a car, you have to deal with frustration of traffic, and you may have to take time off of work to make it to your appointment.
All of this is a lot of hassle, especially for things like follow-up visits, which tend to be quick check-ins, requiring little to no actual testing.
Comparatively, telemedicine would mean that you might be able to simply take your break at work and have a consult over the phone. Even in cases where you still have to go in to some office, it’s likely to be a more convenient one.
For example, there was a case study of telemedicine done by a health network in Flagstaff, AZ. Some of the young patients needed to be seen at the Children’s Health Center in Phoenix. Rather than put parents through a four- to five-hour round-trip drive (and the resultant lost wages) the hospital set up videoconferencing. The Children’s Health Center now sees about 10 Flagstaff patients remotely each week.
Convenience makes a difference
The paper also mentioned a different study looking at newly diagnosed Parkinson’s patients on Flagstaff Native American Reservations. It found that, when in-home telemedicine was an option, patients were more likely to follow up with a neurologist after initial diagnosis. This decreased the number of falls suffered.
Why was there such a difference in follow-up? Well, an in-person visit would have meant an 100-mile round-trip drive to be seen — or 500 miles round-trip if they were referred to a Phoenix specialist. It’s no wonder they were reluctant to keep up on their care!
Another study found that telemedicine can decrease the number of hospitalizations for patients nursing homes. The on-call physicians on nights and weekends tended to refer patients to the ER rather than come in person for an exam. Telemedicine allowed for consultations that resulted in an 11.3% decrease in hospitalizations over a two-year implementation period. Not only does this save Medicare and Medicaid significant amounts of money, it puts the patients (who may already have compromised immune systems) at less risk of exposure to germs and infectious conditions such as MRSA.
The need for telemental health
But for me perhaps the most interesting aspect of telemedicine is the mental health side of things. That’s right: You can get therapy on your phone, outside of office hours.
Beyond the convenience, this is a huge deal because there is currently a shortfall of providers. There are 4,627 mental heath shortage areas across the country, mainly in rural areas. This leaves more than 100 million people without adequate access to traditional counseling.
It’s estimated that one in five people in this country have mental heath issues, yet approximately 60% of those go untreated. Admittedly, sometimes this is due to the stigma surrounding depression, but in other cases it’s due to lack of access.
Even in more centralized areas, it can be difficult to get an appointment with a professional in a timely manner.
I’m always booked at least four weeks out with my therapist to make sure I can get an appointment. Generally we book for up to eight weeks in the future. When Tim wanted to get back into therapy, the two places he called each had a month-long wait. His schedule was completely open, so it wasn’t a matter of just having the wrong times available. There were simply no appointments.
That kind of wait time can discourage people from seeking help.
Get advice on your phone
Telemental health can be had via text, phone sessions or video sessions. That’s great for a few reasons.
First of all, patients only need a cell phone to get help. There’s no worry about how to get to the appointment or fighting depression to leave the house. There were times I could barely leave the apartment for therapy — and a couple of times I didn’t. Having help on a phone would have been a godsend.
Second, they can better schedule the help around jobs or school that might otherwise get missed for traditional therapy.
Third, a provider will be found for you, unlike insurance which simply lists providers, leaving it up to you to find out who is accepting new patients.
Fourth, you can actually start as soon as 24 hours after signing up. That’s huge. As I said before, it’s not uncommon for would-be patients have to wait around a month to get seen for traditional counseling.
Lastly, the discreet nature of the service means that you don’t have to worry about stigma. The stigma of depression (and even of getting help via therapy) is a strong detractor for many people. Being able to participate in counseling from their phone — rather than take time off of work and/or be seen going into a psychologist’s office — is a big attraction for a lot of people.
Does it work?
As the Magic 8 Ball would say: Signs point to yes.
A University of Zurich study looked at 62 patients, half of whom had in-person counseling with the other half going into online therapy. While 50% improved with regular therapy, 53% of online therapy users reported a decrease in depression. Three months after the study, there were no signs of depression in 57% of the online therapy patients, while only 42% of conventional therapy recipients reported the same results.
A UC Berkley study cited a number of other studies which found that the results of online therapy mirror or even exceed the results of traditional counseling. Some of the studies noted that patients often reported feeling more relaxed and comfortable with online therapy, since they were in their own familiar settings.
The UC Berkley study’s own work looked at BetterHelp, which is the largest online mental health provider in the world. The study found that after three months patients saw a significant improvement in their depression symptoms. Specifically, 78% of people classified as having severe depression were no longer considered severely depressed after just three months of use. Of those, 15% had been downgraded to mild depression symptoms — again, after just three months.
The study also questioned participants who had tried both face-to-face counseling and BetterHelp. The latter scored higher in satisfaction, with 98% of people saying that BetterHelp had allowed them to work on their problem (compared to 74% for face-to-face counseling). For probably obvious reasons, it also scored higher in convenience and “help right when I need it.”
Also impressive, 85% of respondents considered the service affordable, as opposed to 66% for face-to-face counseling. (BetterHelp charges $40 to $70 a week, which may be about the same as some people’s co-pays.)
So it seems that telemedicine and telemental health have a lot going for them.
Besides positive study results, the practices are compelling for one simple reason: Convenience reigns supreme in this day and age. Even people who don’t live in rural areas or have mobility/transportation issues aren’t going to enjoy the hassle that comes with taking care of their own health.
Let’s face it, most of us don’t like to do things that are hard — because they’re haaarrrd — and that’s even when depression isn’t at play. Nope, we just don’t want to do things that are difficult, even when we know it’s the best thing for us. Does that mean we’ve gotten a little lazy? Sure, probably. But since that’s not likely to change soon, at least people are finding ways to lean into it without sacrificing their health (mental or otherwise).
Telemedicine and telemental health really seem to have the potential to make life significantly easier — and potentially a lot better — for people who struggle to get the help they need. And that’s really what matters.
Have you ever tried telemedicine or telemental health? Would you?