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doctor on his cell phone

Why In-Person Visits Are Still Important in the Age of Telehealth

Community pharmacies provide crucial preventative and ongoing care that helps patients manage their medical conditions (1). In fact, many patients visit their local pharmacists even more than their primary care physician. Pharmacies have undergone a shift from serving only as medication dispensaries to offering more patient-centric services(2), such as medication therapy management (3), vaccine administration, and compounding activities to increase patient adherence (3). However, for the past decade or more, there has been a shift away from in-person visits to virtual telehealth and telepharmacy screenings — a trend accelerated by the COVID-19 pandemic. Although these remote services provided patients with much-needed remote healthcare during the COVID-19 pandemic, they are not inherently better than traditional brick-and-mortar pharmacies.

The Human Factor: Building Relationships with Patients

Both pre-existing and ongoing relationships between patients and providers are important for high-quality consultations (4). However, telehealth companies often randomly pair patients with physicians, making it impossible for physicians and pharmacists to build the trust with their patients that happens with in-person visits (5). This healthcare model fragments the primary care experience and may disrupt care continuity, which has long been known to improve patient outcomes (6) and is associated with many factors, including a patient’s trust in the provider (7). When pairing patients with random providers, it is almost impossible to build the trust that is necessary for patients to feel comfortable discussing their medical needs with their physicians, thus potentially disrupting the continuity of care.  

Although most patients still prefer telehealth versus in-person visits, some patients choose in-person pharmacy and clinic visits because they prefer face-to-face communication with their pharmacist and greater peace of mind (8). While patient preferences are becoming increasingly important to consider in the era of patient-centric care, physicians must ultimately make the best decision for their patients. This may require an in-person consultation, as it may not be possible for a provider to fully assess a patient’s condition otherwise. 

Technical Barriers May Restrict Patients’ Access to Telehealth

Not all patients have equal access

Telehealth services require the patient to have access to high-speed Internet, devices with cameras, and a private space to conduct a consultation. If patients lack any of these requirements, accessing telehealth services becomes near-impossible. Furthermore, diagnoses and disease monitoring rely on assessing a patient’s appearance, which may be more difficult to do over the Internet compared with in-person. For example, even if a patient has a device with a camera, the resolution may be insufficient for a physician to accurately assess the patient’s condition. Adults may have Internet access but only at a public facility such as a library, preventing them from conducting their consultations privately. 

Access may be especially difficult for elderly patients

These technical barriers are especially acute for elderly patients, who are often uncomfortable or unfamiliar with technology. Although 25 percent of those 65 years and older have Internet access, 36 percent of surveyed people 65 or older do not have broadband. So, even if elderly patients meet all of the necessary requirements to conduct telehealth screenings, they simply may be unable or uncomfortable with using them due to issues such as vision impairments or a lack of technical abilities.

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Telehealth Barriers to Physician Adoption 

Poor interoperability

Incorporating telehealth software into the hospital or pharmacy’s system introduces yet another often un-interoperable piece of software into an already complex and fragmented system that may hinder the sharing of patient information between healthcare facilities (9). 

Monopolization

Telehealth is primed for monopolization, especially regarding the software used. One survey-based study showed that the US market for telehealth software is trending towards monopolization (10), which will likely lead to price increases that are eventually passed onto patients, thus negating any savings from using telehealth applications. Past healthcare mergers have often resulted in increased prices for patients without a corresponding increase in the quality of care.

Security risks and fraud

Telehealth companies are ripe for ransomware attacks. These issues were likely magnified when providers were allowed to use unsecure modes of communication with their patients when the HHS relaxed HIPAA regulations due to COVID-19. This allowed telehealth providers to provide screenings to their patients via unsecure channels such as FaceTime and Messenger. As these regulations have only recently been reinstated, it is unclear how many telehealth companies and providers are still using these insecure channels of communication. Security risks include transmitting private health information to the wrong patient or storing unencrypted health information, such as recorded video sessions, all of which are susceptible to ransomware attacks. 

Although it’s unclear if telehealth companies are more susceptible to fraud than in-person facilities, there have been several concerning reports. The Office of Inspector General (OIG) released a statement in 2021 that warned of a fraud scheme involving telehealth companies that incentivized providers to refer patients via kickbacks for prescribing medically unnecessary items and services.

Why You Should Choose a Community Pharmacy Like VLS Pharmacy and New Drug Loft

Although it is tempting to think that telehealth and telepharmacy services have expanded the accessibility of healthcare to everyone, that is simply not the case. Many patients may lack the necessary technology to enable effective visits with a physician or pharmacist. Community pharmacies such as VLS Pharmacy and New Drug Loft form the cornerstone of patient care, providing much-needed face-to-face interactions and relationship-building that are often impossible to accomplish virtually.

 

Please comment below with any thoughts or questions. Reach out to our team to learn about building trust and long-lasting patient relationships. All medications from VLS Pharmacy and New Drug Loft are prepared in a lab that follows safety and quality standards per our status as a 503A pharmacy.

 

References

  1. Berenbrok LA, Gabriel N, Coley KC, Hernandez I. Evaluation of Frequency of Encounters With Primary Care Physicians vs Visits to Community Pharmacies Among Medicare Beneficiaries. JAMA Network Open. 2020;3(7):e209132. doi:10.1001/jamanetworkopen.2020.9132
  2. McPherson T, Fontane P. Patient-centered care in the community-based compounding practice setting. Journal of the American Pharmacists Association. 2010;50(1):37-44. doi:10.1331/JAPhA.2010.09020
  3. Pharmaceuticals | Free Full-Text | The Role of Pharmaceutical Compounding in Promoting Medication Adherence. Accessed November 27, 2023. https://www.mdpi.com/1424-8247/15/9/1091
  4. The impact of remote care approaches on continuity in primary care: a mixed-studies systematic review | British Journal of General Practice. Accessed December 5, 2023. https://bjgp.org/content/73/730/e374
  5. Esmalipour R, Salary P, Shojaei A. Trust-building in the Pharmacist-patient Relationship: A Qualitative Study. Iran J Pharm Res. 2021;20(3):20-30. doi:10.22037/ijpr.2020.114113.14675
  6. Cabana MD, Jee SH. Does continuity of care improve patient outcomes? J Fam Pract. 2004;53(12):974-980.
  7. Donahue KE, Ashkin E, Pathman DE. Length of patient-physician relationship and patients’ satisfaction and preventive service use in the rural south: a cross-sectional telephone study. BMC Fam Pract. 2005;6:40. doi:10.1186/1471-2296-6-40
  8. Moulaei K, Shanbehzadeh M, Bahaadinbeigy K, Kazemi-Arpanahi H. Survey of the patients’ perspectives and preferences in adopting telepharmacy versus in-person visits to the pharmacy: a feasibility study during the COVID-19 pandemic. BMC Medical Informatics and Decision Making. 2022;22(1):99. doi:10.1186/s12911-022-01834-5
  9. Zhang X, Saltman R. Impact of Electronic Health Record Interoperability on Telehealth Service Outcomes. JMIR Med Inform. 2022;10(1):e31837. doi:10.2196/31837
  10. Walia B, Shridhar A, Arasu P, Singh GK. US Physicians’ Perspective on the Sudden Shift to Telehealth: Survey Study. JMIR Hum Factors. 2021;8(3):e26336. doi:10.2196/26336

 


 

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