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Chief Medical Officer
Philadelphia FIGHT Community Health Centers
Division of Infectious Diseases
Perelman School of Medicine
University of Pennsylvania
Stacey Trooskin, MD, PhD, MPH, has disclosed that she has received funds for research support and consulting fees from Gilead Sciences.
Every Wednesday, my clinic hours in our Federally Qualified Health Center are dedicated to seeing patients with hepatitis C virus (HCV). Last week, it was late afternoon when I hurried down the hall after showing a patient to the lab and sat down at my computer to begin the last visit of my day. I clicked on the virtual waiting room, and there she was—waiting for me to start the visit to discuss how we would cure her chronic HCV infection. She was seated alone in a gray-walled room in the lower level of the inpatient drug treatment program that she would call home for the next 60-90 days.
Before the pandemic, residents of the same inpatient program had the option to travel to our clinic for in-person HCV care if they screened positive for HCV on intake. However, the logistics of getting them to our health center—only 20 minutes by public transportation—were formidable. Patients could leave the inpatient facility only in the afternoon, and 4 patients at a time were allowed to travel to our health center, with 1 of our patient navigators serving as a chaperone. Due to scheduling constraints, we were unable to see the patients simultaneously. Instead, we would see them sequentially, causing the patients and our navigator to spend their entire afternoon in the waiting area. This was far from ideal.
Pivot to Telemedicine
The COVID-19 pandemic has stressed the US healthcare system in countless ways. We have lost patients, colleagues, and loved ones. One thing that the COVID-19 pandemic has given us, however, is the impetus to be nimble and creative and to cut through some of the red tape that may otherwise hinder our ability to meet patients where they are. Telemedicine is a good example of pandemic-inspired flexibility that has allowed us to deliver care to patients in a new way—new, at least, for the US healthcare system. We have been able to increase our linkage rates to HCV care through telemedicine and our partnership with this inpatient treatment program. Patients can be seen by an HCV provider remotely and miss little, if any, of their inpatient programming. We also have embedded an on-site phlebotomist within that facility so that pre-HCV treatment labs can be drawn at the time of their televisit.
A Useful Supplement
Is seeing a patient via camera the same as an in-person visit? Definitely not. Do I miss laying hands on my patients and sharing space with them? I sure do. Am I able to connect with my patients through a screen in a meaningful way? I think so—but not in the same way. Telemedicine is not meant to replace all in-person visits, but it is a useful supplement and a great vehicle for engaging individuals in care.
An Uncertain Future
The future of financial reimbursement for telemedicine is uncertain. Emergency health waivers and flexibilities ordered by our governor at the start of the pandemic allowed us to rapidly implement telemedicine. Yet, despite rising cases of the SARS-CoV-2 delta variant, the COVID-19 emergency healthcare waivers are set to expire unless our lawmakers grant an extension. We all crave a return to a semblance of our prepandemic lives, but with this comes the realization that some things, once experienced, cannot and should not be lost. Telemedicine is one of those things.
Have you pivoted to telemedicine during the COVID-19 pandemic, and would you like to continue offering virtual visits in the future? Answer the polling question and join the conversation by posting in the discussion section.