Since the start of the COVID-19 pandemic, the phrase “the doctor will see you now” has taken on a whole new meaning. More than ever, being seen by the doctor now involves looking into a screen of some kind.
As we consider the impacts of the pandemic on our lives and healthcare system, the increased use and acceptance of telehealth is likely to be among those that are set to endure. The implications of this for pharmaceutical care may be significant.
Telehealth is the provision of healthcare remotely by means of telecommunications technology. This can mean virtual visits (like FaceTime), phone calls, remote patient monitoring, or secure chat or messaging.
Since the start of the crisis, the use of telehealth has skyrocketed. In Medicare, per CMS, the number of patients using telehealth has increased from roughly 11,000 a week pre-pandemic to 1.3 million people a week now.1
And government and private payers have enabled these changes. Medicare has broadly expanded telehealth coverage and access by adding dozens of additional service types, expanding the list of eligible providers, removing geographic and technology restrictions, and expanding the types of services that can be delivered telephonically. Most commercial plans have similarly expanded access to telehealth by waiving or lowering cost-sharing for telehealth and expanding coverage for telehealth services. State Medicaid programs have also meaningfully expanded coverage and reimbursement of a broad range of telehealth services.
Of course, we don’t know now how long this crisis will disrupt the ability of people to see their clinicians in person. We do know that telehealth is not a substitute for most in-person visits, especially for individuals without easy access to needed technology or for those conditions for which nothing short of a hands-on experience will do.
However, it is reasonable to believe that, at least for some time, in-person visits will continue to represent an unacceptable risk for many patients and their providers. It is also likely that, as people and providers gain more experience with, and associated comfort with, telehealth, the expanded coverage and increased payment for telehealth will become embedded in our healthcare system.
From a therapeutics perspective, the increased use of telehealth could substantially improve access to needed treatments and compliance with them. Most fundamentally, telehealth’s ability to reduce barriers to provider-patient interaction could increase the opportunities for patients to become aware of available therapies. Such awareness could lead to further evaluation, including testing, and the electronic transmission of a new prescription. While telehealth will never fully replace in-person care, it can be an excellent option in many clinical situations and as a component of integrated in-person and virtual care models, especially for patients with chronic conditions who benefit from continuous and frequent touch-points with their providers.
Perhaps more importantly, the increased contact between people and their healthcare professionals could encourage better adherence to medications. The FDA defines adherence as “the extent to which patients take medication as prescribed …,” which includes “factors such as getting prescriptions filled, remembering to take medication on time, and understanding the directions.”2
While there is much diversity in adherence among different health conditions and types of patients, some studies suggest that medication adherence for some conditions may be 50 percent or less.3 When patients do not fill their prescription or take it as directed, their health can suffer and that can add significant costs to healthcare when treatment is delayed. Of course, lack of adherence also impacts adversely pharmaceutical company sales.
While more research is needed, studies across a range of medical conditions have begun to suggest that telehealth interventions can significantly improve medication adherence, especially for people with chronic health conditions.4 For example, a recent randomized controlled study found that telehealth significantly improved medication adherence in adults with severe mental illness as measured by the Medication Adherence Report Scale.5 While the causes of nonadherence are multifactorial, it makes sense that eliminating barriers to patient-provider interaction as allowed by telehealth would increase opportunities for providers and patients to engage in the communications that are proven to lead to better adherence.
The health challenge presented by COVID-19 can present some silver linings. One of those may be the long-term benefit people will experience from telehealth’s improvements to medication adherence and, consequently, patient health. At the same time, this will present pharmaceutical companies with an important business opportunity.
3 https://apps.who.int/iris/bitstream/handle/10665/42682/9241545992.pdf; https://pubmed.ncbi.nlm.nih.gov/17101639/
4 https://pubmed.ncbi.nlm.nih.gov/30651059/; https://onlinelibrary.wiley.com/doi/abs/10.1111/jan.14319; https://www.sciencedirect.com/science/article/abs/pii/S2589419620301265; https://via.library.depaul.edu/nursing-colloquium/2019/summer/20/